Methods for treating ulcerative colitis

ABSTRACT

The present disclosure provides methods and treatment regimens for treating ulcerative colitis in a subject in need thereof. In particular, the methods described herein comprise treating a subject in need thereof with a treatment regimen comprising the administration of a pharmaceutical composition comprising live non-pathogenic fecal bacteria for at least 8 weeks and at least three times per week. In an aspect, the subject in need thereof exhibits a Mayo endoscopy score of 3 or lower. In some aspects, the subject in need thereof has no concomitant corticosteroid use during said method and has no corticosteroid use immediately prior to commencing said method.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a U.S. Non-Provisional application which is acontinuation of International Application No. PCT/US2017/045092 filedAug. 2, 2017, which claims the benefit of U.S. Provisional ApplicationNo. 62/370,508 filed Aug. 3, 2016, which is incorporated by reference inits entirety herein.

FIELD

The present disclosure relates to methods and dosing regimens suitablefor treating ulcerative colitis in a subject in need thereof.

BACKGROUND

Mammals harbor diverse microbial species in their gastrointestinal (GI)tracts. Interactions between these microbes and between microbes and thehost, e.g. the host immune system, shape a microbiota. A healthymicrobiota provides the host with multiple benefits, includingcolonization resistance to a broad spectrum of pathogens, essentialnutrient biosynthesis and absorption, and immune stimulation thatmaintains a healthy gut epithelium and an appropriately controlledsystemic immunity. An unbalanced microbiota (also called ‘dysbiosis’ ordisrupted symbiosis) may lose its function and results in increasedsusceptibility to pathogens, altered metabolic profiles, or induction ofproinflammatory signals that can lead to local or systemic inflammationor autoimmunity. The intestinal microbiota plays a significant role inthe pathogenesis of many disorders such as pathogenic infections of thegut.

Ulcerative colitis is a chronic disease of the large intestine, alsoknown as the colon, in which the lining of the colon becomes inflamedand develops tiny open sores, or ulcers, that produce pus and mucous.Ulcerative colitis occurs most often in people ages 15 to 30, althoughthe disease may afflict people of any age. It affects men and womenequally and appears to run in some families.

Ulcerative colitis is a disease that is characterized by inflammationand micro-ulcers in the superficial layers of the large intestine. Theinflammation usually occurs in the rectum and lower part of the colon,but it may affect the entire large intestine (pancolitis). Ulcerativecolitis can very rarely affect the small intestine in its distal portion(Backwash Ileitis).

The inflammation is accompanied usually with diarrhea, which may beprofuse and bloody. Micro-ulcers form in places where inflammation hasdestroyed the cells lining the bowel and these areas bleed and producepus and mucus. Ulcerative colitis, especially when mild, can bedifficult to diagnose because symptoms are similar to other intestinaldisorders, most notably the other type of Irritable Bowel Diseases (IBD)called Crohn's disease and also irritable bowel syndrome. Crohn'sdisease differs from ulcerative colitis because it causes inflammationthroughout the whole thickness of the intestinal wall and produces deepulcers. Crohn's disease usually occurs in the small intestine, but itcan also occur in the large intestine, anus, esophagus, stomach,appendix and mouth. Crohn's disease causes fistulae whereas ulcerativecolitis does not. Both Crohn's and ulcerative colitis may co-exist inthe same patient. The combination of inflammation and ulceration cancause abdominal discomfort and frequent emptying of the colon. Existingtreatments for ulcerative colitis involve intense and lengthycombinational drug therapy with significant side effects or even requiresurgery to remove part of the colon. Moreover, a substantial proportionof ulcerative colitis patients are resistant to standard drug therapy.Thus, there is a need for more effective treatments for ulcerativecolitis that are easier to administer.

Implantation or administration of human colonic microbiota into thebowel of a sick patient is called Fecal Microbiota Transplantation(FMT), also commonly known as fecal bacteriotherapy. FMT is believed torepopulate the gut with a diverse array of microbes that control keypathogens by creating an ecological environment inimical to theirproliferation and survival. It represents a therapeutic protocol thatallows a fast reconstitution of a normal compositional and functionalgut microbial community.

Fecal microbiota transplantation (FMT), also known as ‘fecalbacteriotherapy,’ represents the one therapeutic protocol that allowsthe fastest reconstitution of a normal composition and functional gutmicrobial community. For many decades, FMT has been offered by selectcenters across the world, typically as an option of last resort forpatients with recurrent Clostridium difficile infection (CDI). FMT hasalso been suggested in treating other gut infective agents such as E.coli and Vancomycin resistant Enterococci (VRE). Currently, FMT isadministered by several routes including infusion of human microbiota inthe form of homogenized stool, extracts of homogenized stool, orcultured stool components through a colonoscope, an enema, or via anasojejunal tube.

SUMMARY

The present disclosure provides methods and dosing regimens for treatingor preventing ulcerative colitis.

In one aspect, the present disclosure provides a method for treatingulcerative colitis in a subject in need thereof, where the methodcomprises treating said patient with a treatment regimen comprising theadministration of a pharmaceutical composition comprising livenon-pathogenic fecal bacteria for at least 8 weeks and at least threetimes per week.

In an aspect, this disclosure provides a method for treating ulcerativecolitis (UC) in a subject in need thereof and exhibiting a Mayoendoscopy score of 3 or lower, where the method comprises administeringto said subject a pharmaceutical composition comprising livenon-pathogenic fecal bacteria.

In an aspect, the present disclosure provides a method for treatingulcerative colitis in a subject in need thereof, where the methodcomprises administering to the subject a pharmaceutical compositioncomprising live non-pathogenic fecal bacteria, where the subject has noconcomitant corticosteroid use during the method and has nocorticosteroid use immediately prior to commencing the method.

In one aspect, the present disclosure provides a method for selecting atreatment plan for treating ulcerative colitis (UC) in a subject in needthereof, where the method comprises determining the level ofFusobacterium, Sutterella, or both in said subject's gut; andrecommending a fecal bacteria-based therapy when said level ofFusobacterium, Sutterella, or both is above a predetermined level.

In an aspect, the present disclosure provide as method for selecting atreatment plan for treating ulcerative colitis (UC) in a subject in needthereof, where the method comprises determining the level of one or morebacteria selected from the group consisting of Barnesiella,Parabacteroides, Clostridium IV, Ruminococcus, Blautia, Dorea,Ruminococcus2, and Clostridium XVIII in said subject's gut; andrecommending a fecal bacteria-based therapy when said level of one ormore bacteria selected from the group consisting of is above apredetermined level.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows a study patient CONSORT Flow Diagram in accordance withExample 1 of the present disclosure;

FIG. 2 shows a graphical representation of the study design inaccordance with Example 4 of the present disclosure;

FIG. 3A shows the number of patients in the FMT and placebo-treatedgroups achieving the primary outcome of steroid-free clinical remissionand endoscopic remission or response at week 8 after therapy inaccordance with Example 5 of the present disclosure;

FIG. 3B shows the number of patients in steroid-free clinical remissionand clinical response at week 8 after therapy in accordance with theExamples of the present disclosure;

FIG. 3C shows the number of patients with steroid-free endoscopicresponse and complete mucosal healing after therapy in accordance withthe Examples of the present disclosure;

FIG. 4A shows an exemplary baseline endoscopic appearance of 25 cmrecto-sigmoid active colitis in accordance with Example 5 of the presentdisclosure;

FIG. 4B shows an exemplary endoscopic appearance at end of week 8blinded FMT therapy in accordance with Example 5 of the presentdisclosure;

FIG. 4C shows an exemplary baseline endoscopic appearance of extensivecolitis to the hepatic flexure in accordance with Example 5 of thepresent disclosure;

FIG. 4D shows an exemplary endoscopic appearance at the completion of 8weeks open-label FMT in accordance with Example 5 of the presentdisclosure;

FIG. 5 shows the speed of onset of therapy in accordance with Example 5of the present disclosure;

FIG. 6A shows the number of operational taxonomic units (OTUs) per fecalsample in accordance with Example 6 of the present disclosure;

FIG. 6B shows the phylogenetic diversity within each fecal sample inaccordance with Example 6 of the present disclosure;

FIG. 6C shows the principal component analysis of fecal samples at thegenus taxonomic level in accordance with Example 6 of the presentdisclosure;

FIG. 6D shows the number of OTUs in blinded study patients on FMTtherapy, according to primary outcome, individual donors, and donorbatches in accordance with Example 6 of the present disclosure.

FIG. 7A shows the endoscopy images of (left 1 and 2) marked UCinflammation of the rectum prior to treatment; (right 1) dramaticreduction in inflammation with stool attaching to the mucosa at week 20;(left 3 and 4) marked UC inflammation in the sigmoid colon prior totreatment; and (right 2 and 3) marked reduction in inflammation in thesigmoid colon at week 20.

FIG. 7B shows the endoscopy images of (left 7, 8, 9, and 10)inflammation and significant mucus in the traverse colon at week 8post-treatment; and (right 6) improvement in inflammation at week 20.

DETAILED DESCRIPTION

Before the present compositions and methods are described, it is to beunderstood that the present disclosure is not limited to the particularprocesses, compositions, or methodologies described, as these may vary.It is also to be understood that the terminology used in the descriptionis for the purpose of describing the particular versions or embodimentsonly, and is not intended to limit the scope of the present inventionwhich will be limited only by the appended claims. For example, featuresillustrated with respect to one embodiment may be incorporated intoother embodiments, and features illustrated with respect to a particularembodiment may be deleted from that embodiment. Thus, the disclosurecontemplates that in some embodiments of the disclosure, any feature orcombination of features set forth herein can be excluded or omitted. Inaddition, numerous variations and additions to the various embodimentssuggested herein will be apparent to those skilled in the art in lightof the instant disclosure, which do not depart from the instantdisclosure. In other instances, well-known structures, interfaces, andprocesses have not been shown in detail in order not to unnecessarilyobscure the invention. It is intended that no part of this specificationbe construed to effect a disavowal of any part of the full scope of theinvention. Hence, the following descriptions are intended to illustratesome particular aspects of the disclosure, and not to exhaustivelyspecify all permutations, combinations and variations thereof.

Unless defined otherwise herein, terms are to be understood according toconventional usage by those of ordinary skill in the relevant art. Theterminology used in the description of the disclosure herein is for thepurpose of describing particular embodiments only and is not intended tobe limiting of the disclosure.

All publications, patent applications, patents and other referencescited herein are incorporated by reference in their entireties.

Unless the context indicates otherwise, it is specifically intended thatthe various features of the disclosure described herein can be used inany combination. Moreover, the present disclosure also contemplates thatin some embodiments of the disclosure, any feature or combination offeatures set forth herein can be excluded or omitted.

Methods disclosed herein can comprise one or more steps or actions forachieving the described method. The method steps and/or actions may beinterchanged with one another without departing from the scope of thepresent invention. In other words, unless a specific order of steps oractions is required for proper operation of the embodiment, the orderand/or use of specific steps and/or actions may be modified withoutdeparting from the scope of the present invention.

As used in the description of the disclosure and the appended claims,the singular forms “a,” “an” and “the” are intended to include theplural forms as well, unless the context clearly indicates otherwise.

As used herein, “and/or” refers to and encompasses any and all possiblecombinations of one or more of the associated listed items, as well asthe lack of combinations when interpreted in the alternative (“or”).

The terms “about” and “approximately” as used herein when referring to ameasurable value such as a percentages, density, volume and the like, ismeant to encompass variations of 20%, 10%, 5%, 1%, 0.5%, or even 0.1% ofthe specified amount.

As used herein, phrases such as “between X and Y” and “between about Xand Y” should be interpreted to include X and Y. As used herein, phrasessuch as “between about X and Y” mean “between about X and about Y” andphrases such as “from about X to Y” mean “from about X to about Y.”

The term “substantially free” as used herein when referring to asubstance's presence in a composition, is meant to encompass that thesubstance constitutes less than 1%, less than 0.5%, less than 0.1%, oreven less than 0.01% of the whole substance by volume or mass.

As used herein, the term “treating” refers to (i) completely orpartially inhibiting a disease, disorder or condition, for example,arresting its development; (ii) completely or partially relieving adisease, disorder or condition, for example, causing regression of thedisease, disorder and/or condition; or (iii) completely or partiallypreventing a disease, disorder or condition from occurring in a patientthat may be predisposed to the disease, disorder and/or condition, buthas not yet been diagnosed as having it. Similarly, “treatment” refersto both therapeutic treatment and prophylactic or preventative measures.

As used herein, “therapeutically effective amount” or “pharmaceuticallyactive dose” refers to an amount of a composition which is effective intreating the named disease, disorder or condition.

As used herein, “microbiota,” and “flora” refer to a community ofmicrobes that live in or on a subject's body, both sustainably andtransiently, including eukaryotes, archaea, bacteria, and viruses(including bacterial viruses (i.e., phage)). A non-selective fecalmicrobiota refers to a community or mixture of fecal microbes derivedfrom a donor's fecal sample without selection and substantiallyresembling microbial constituents and population structures found insuch fecal sample.

As used herein, “remission,” “cure,” or “resolution rate” refers to thepercentage of patients that are cured or obtain remission or completeresolution of a condition in response to a given treatment. As usedherein, “clinical remission sustaining rate” refers to the percentage ofpatients remaining in clinical remission after a specifiedpost-treatment period among all patients who achieve remission at thecompletion of a treatment. Quantitatively, remission, cure, orresolution is achieved when a patient's UCDAI score is below or equal to2, assessed after 8 weeks of treatment. Remission, cure, or resolutioncan be further confirmed by endoscopic and mucosal healing.

As used herein “steroid-free” refers to a complete lack or a substantiallack of steroid use.

As used herein, “primary outcome rate” refers to the percentage ofpatients achieving primary outcome after a specific treatment ortreatment regimen among all patients receiving that treatment ortreatment regimen.

As used herein, “response rate” refers to the percentage of patientsthat respond positively to a given treatment. Quantitatively, a patientresponds to a treatment positively when the patient's UCDAI scoredecreases by at least 2 from baseline to week 8.

As used herein, “Mayo Clinic score” or “Mayo score” refers to an indexsystem for assessing the severity of a ulcerative colitis diseasecondition. See Table 1 and Schoeder et al. N Engl J Med 1987;317:1625-9. The Mayo Clinic score ranges from 0-12, with sub-scores of0-3, where the higher scores indicate more severe disease. In someaspects, sub-scores may be rated for stool frequency, rectal bleeding,mucosal appearance at endoscopy, and physician's global assessment(PGA).

TABLE 1 Mayo Clinic Scoring System for Assessment of Ulcerative ColitisActivity (Shoeder et al.) score assignment 1. Stool frequency* Normalnumber of stools for this patient 0 1-2 stools more than normal 1 3-4stools more than normal 2 5 or more stools more than normal 3 2. RectalBleeding† No blood seen 0 Streaks of blood with stool less half the time1 Obvious blood with stool most of the time 2 Blood alone passed 3 3.Findings of flexible proctosigmoidoscopy Normal or inactive disease 0Mild disease (erythema, decreased vascular pattern, 1 mild friability)Moderate disease (marked erythema, absent vascular 2 pattern,friability, erosions) Severe disease (spontaneous bleeding, ulceration)3 4. Physician 's global assessment‡ Normal 0 Mild disease 1 Moderatedisease 2 Severe disease 3 *Each patient served as his or her owncontrol to establish the degree of abnormality of the stool frequency†The daily bleeding score represented the most severe bleeding of theday ‡The physician's global assessment acknowledged the three othercriteria, the patient's daily record of abdominal discomfort and generalsense of well-being, and other observations, such as physical findingsand the patient's performance status

As used herein, “ulcerative colitis endoscopic index of severity” or“UCEIS” refers to an index for assessing endoscopic disease activity.The index assesses three criteria, including vascular pattern, bleeding,and erosions and ulcers (Table 2). See Travis et al., Developing aninstrument to assess the endoscopic severity of ulcerative colitis: theUlcerative Colitis Endoscopic Index of Severity (UCEIS), Gut 2012,61(4):535-42. A higher score reflects increased disease severity.

TABLE 2 Scoring System for Ulcerative Colitis Endoscopic Index ofSeverity (See Travis et al.) score assignment 1. Vascular patternNormal: Normal vascular pattern with arborization of 1 capillariesclearly defined, or with blurring or patchy loss of capillary marginsPatchy obliteration: Patchy obliteration of vascular pattern 2Obliterated: Complete obliteration of vascular pattern 3 2. Rectalbleeding None: No visible blood 1 Mucosal: Some spots or streaks ofcoagulated blood on the 2 surface of the mucosa ahead of the scope,which can be washed away Luminal mild: Some free liquid blood in thelumen 3 Luminal moderate or severe: Frank blood in the lumen 4 ahead ofendoscope or visible oozing from mucosa after washing intra-luminalblood, or visible oozing from a hemorrhagic mucosa 3. Erosions andulcers None: Normal mucosa, nonvisible erosions or ulcers 1 Erosions:Tiny (≥5 mm) defects in the mucosa, of a white 2 or yellow color with aflat edge Superficial ulcer: Larger (>5 mm) defects in the mucosa, 3which are discrete fibrin-covered ulcers when compared to erosions, butremain superficial Deep ulcer: Deeper excavated defects in the mucosa,with a 4 slightly raised edge

As used herein, “ulcerative colitis disease activity index” or “UCDAI”refers to an index system for assessing the symptomatic severity orresponse of a ulcerative colitis patient. The index assesses fourvariables, which include stool frequency, severity of bleeding, colonicmucosal appearance, and the physician's overall assessment of diseaseactivity (Table 3). See Sutherland et al., 5-Aminosalicylic acid enemain the treatment of distal ulcerative colitis, proctosigmoiditis, andproctitis. Gastroenterology. 1987; 92:1894-8. Each variable is scoredfrom 0-3 so that the total index score ranges from 0-12; 0-2: remission;3-6: mild; 7-10: moderate; >10: severe ulcerative colitis.

TABLE 3 Scoring System for Ulcerative Colitis Disease Activity Index.(See Tursi et al.) score assignment 1. Stool frequency Normal 0 1-2Stools/day > normal 1 3-4 Stools/day > normal 2 >4 Stools/day > normal 32. Rectal bleeding None 0 Streaks of blood 1 Obvious blood 2 Mostlyblood 3 3. Mucosal appearance Normal 0 Mild friability 1 Moderatefriability 2 Exudation, spontaneous bleeding 3 4. Physician's rating ofdisease activity Normal 0 Mild 1 Moderate 2 Severe 3

As used herein, “eukaryotic” refers to belonging to a cell that containsa nucleus and membrane-bound organelles.

As used herein, “bacteria,” “bacterium,” and “archaea” refer tosingle-celled prokaryotes that lack membrane bound nuclei and lackorganelles.

As used herein, “fecal bacteria” refers to bacteria that can be found infecal matter.

As used herein, “viable” means possessing the ability to multiply.

As used herein, “isolated” or “purified” refers to a bacterium or otherentity or substance that has been (1) separated from at least some ofthe components with which it was associated when initially produced(whether in nature or in an experimental setting), and/or (2) produced,prepared, purified, and/or manufactured by the hand of man. Isolated orpurified bacteria can be separated from at least about 10%, about 20%,about 30%, about 40%, about 50%, about 60%, about 70%, about 80%, about90%, or more of the other components with which they were initiallyassociated.

As used herein, the terms “pathogen” and “pathogenic” in reference to abacterium or any other organism or entity includes any such organism orentity that is capable of causing or affecting a disease, disorder orcondition of a host organism containing the organism or entity.

As used herein, “spore” or a population of “spores” includes bacteria(or other single-celled organisms) that are generally viable, moreresistant to environmental influences such as heat and bacteriocidalagents than vegetative forms of the same bacteria, and typically capableof germination and out-growth. “Spore-formers” or bacteria “capable offorming spores” are those bacteria containing the genes and othernecessary abilities to produce spores under suitable environmentalconditions.

As used herein, a “combination” of two or more bacteria includes thephysical co-existence of the two bacteria, either in the same materialor product or in physically connected products, as well as the temporalco-administration or co-localization of the two bacteria.

As used herein, “subject” refers to any animal subject including humans,laboratory animals (e.g., primates, rats, mice), livestock (e.g., cows,sheep, goats, pigs, turkeys, chickens), and household pets (e.g., dogs,cats, rodents, etc.). The subject or patient may be healthy, or may besuffering from an infection due to a gastrointestinal pathogen or may beat risk of developing or transmitting to others an infection due to agastrointestinal pathogen.

As used herein, “Shannon Diversity Index” refers to a diversity indexthat accounts for abundance and evenness of species present in a givencommunity using the formula

$H = {- {\sum\limits_{i = 1}^{R}{p_{i}\ln\; p_{i}}}}$where H is the Shannon Diversity Index, R is the total number of speciesin the community, and p_(i) is the proportion of R made up of the ithspecies. Higher values indicate diverse and equally distributedcommunities, and a value of 0 indicates only one species is present in agiven community. For further reference, see Shannon and Weaver, (1949)The mathematical theory of communication. The University of IllinoisPress, Urbana. 117 pp.

As used herein, “operational taxonomic unit” or “OTU” refers to a groupof closely related microbial species determined based on 16S or 18S rRNAmarker genes.

As used herein, “antibiotic” refers to a substance that is used to treatand/or prevent bacterial infection by killing bacteria, inhibiting thegrowth of bacteria, or reducing the viability of bacteria.

As used herein, an “intermittent dosing schedule” means that atherapeutic composition is administered for a period of time followed bya period of time (a treatment period) where treatment with suchtherapeutic composition is withheld (a rest period). Intermittent dosingregimens can be expressed as treatment period in days or weeks/restperiod in days or weeks. For example, a 4/1 intermittent dosing schedulerefers to an intermittent dosing schedule where the treatment period isfour weeks/days and the rest period is one week/day.

As used herein, a “continuous dosing schedule” refers to a dosingschedule where a therapeutic composition is administered during atreatment period without a rest period. Throughout the treatment periodof a continuous dosing schedule, a therapeutic composition can beadministered, for example, daily, or every other day, or every thirdday. On a day when a therapeutic composition is administered, it can beadministered in a single dose, or in multiple doses throughout the day.

As used herein, “dosing frequency” refers to the frequency ofadministering doses of a therapeutic composition in a given time. Dosingfrequency can be indicated as the number of doses per a given time, forexample, once per day, once a week, or once in two weeks.

As used herein, “dosing interval” refers to the amount of time thatelapses between multiple doses being administered to a subject.

Different types of ulcerative colitis exist. As used herein, “ulcerativeproctitis” refers to a disease form where bowel inflammation is limitedto the rectum. Because of its limited extent (usually less than the sixinches of the rectum), ulcerative proctitis tends to be a milder form ofulcerative colitis. It is associated with fewer complications and offersa better outlook than more widespread disease. For approximately 30% ofall patients with ulcerative colitis, the illness begins as ulcerativeproctitis.

As used herein, “proctosigmoiditis” refers to a form of colitisaffecting the rectum and the sigmoid colon, the lower segment of colonlocated right above the rectum. Symptoms include bloody diarrhea,cramps, and a constant feeling of the need to pass stool, known astenesmus. Moderate pain on the lower left side of the abdomen may occurin active disease.

As used herein, “left-sided colitis” refers to continuous inflammationthat begins at the rectum and extends as far as a bend in the colon nearthe spleen called the splenic flexure. Symptoms include loss ofappetite, weight loss, diarrhea, severe pain on the left side of theabdomen, and bleeding.

As used herein, “pan-ulcerative (total) colitis” affects the entirecolon. Symptoms include diarrhea, severe abdominal pain, cramps, andextensive weight loss. Potentially serious complications include massivebleeding and acute dilation of the colon (toxic megacolon), which maylead to an opening in the bowel wall. Serious complications may requiresurgery.

Several theories have been proposed for the cause of ulcerative colitis.There is some evidence to suggest that the body's immune system reactsto an environmental, dietary or infectious agent in geneticallysusceptible individuals causing inflammation in the intestinal wall. Thelatest postulated causal agent is the to be an infection of the liningwith a Fusobacterium varium identified by researchers from Japan.Ulcerative colitis is not caused by emotional distress or sensitivity tocertain foods or food products but these factors may trigger symptoms insome people. Ulcerative colitis is most likely not an aberrant reactionbut an infection.

The most common symptoms of ulcerative colitis are bloody diarrhea andabdominal pain. Patients also may experience fever, rectal bleeding,fatigue, anaemia, loss of appetite, weight loss and loss of body fluidsand nutrients resulting in nutritional deficiencies. These symptomsoccur as intermittent attacks in between periods when the symptoms goaway (remissions). These disease-free periods can last for months oreven years. Usually an attack begins with increased urgency to defecate,mild lower abdominal cramps, and blood and mucus in the stools.

Ulcerative colitis may cause long-term problems such as arthritis,inflammation of the eye, liver disease (fatty liver, hepatitis,cirrhosis, and primary sclerosing cholangitis), osteoporosis, skinrashes, anaemia and kidney stones. These complications may occur whenthe immune system triggers inflammation in other parts of the body.These problems can disappear when the colitis is treated effectively.

Treatment for ulcerative colitis depends on the seriousness of thedisease. Most people are treated with medication. Some people whosesymptoms are triggered by certain foods are able to control the symptomsby avoiding foods that upset their intestines, like highly seasonedfoods or dairy products. Each person may experience ulcerative colitisdifferently, so treatment is adjusted for each individual.

Many patients with mild or moderate disease are first treated with 5-ASAagents, including a combination of the drugs 5-aminosalicylic acids andsulfasalazine that helps control inflammation. Sulfasalazine is the mostcommonly used of these drugs. Sulfasalazine can be used for as long asneeded and can be given along with other drugs. Patients who do not dowell on sulfasalazine may respond to newer 5-ASA agents. Possible sideeffects of 5-ASA preparations include nausea, vomiting, heartburn,diarrhea and headache.

People with severe disease and those who do not respond to 5-ASApreparations may be treated with added corticosteroids. Prednisone andbudesonide and hydrocortisone are corticosteroids used to reduceinflammation. They can be given orally, intravenously, through an enema,or in a suppository, depending on the location of the inflammation.Corticosteroids can cause side effects such as weight gain, acne, facialhair, hypertension, diabetes, mood swings, and increased risk ofinfection, so doctors carefully monitor patients taking thesemedications.

Immunosuppressants such as azathioprine, 6-mercaptopurine (6-MP) andmethotrexate are often used and can make a marked improvement at a lowdose with few side effects. Other drugs may be given to relax thepatient or to relieve pain, diarrhea, or infection. Occasionally,symptoms are severe enough that the person must be hospitalized. Forexample, a person may have severe bleeding or severe diarrhea thatcauses dehydration. In such cases the doctor will try to stop diarrheaand loss of blood, fluids, and mineral salts. The patient may need aspecial diet, feeding through a vein, medications, or sometimes surgery.

In severe cases, a patient may need surgery to remove the diseasedcolon. Sometimes the doctor will recommend removing the colon if medicaltreatment fails or if the side effects of corticosteroids or other drugsthreaten the patient's health.

In one aspect, the present disclosure provides a method for reducing thelevel of calprotectin in a subject in need thereof, where the methodcomprises treating said patient with a treatment regimen comprising theadministration of a pharmaceutical composition comprising livenon-pathogenic fecal bacteria for at least 8 weeks and at least threetimes per week. In another aspect, any method or treatment regimenprovided here can also be used to reduce the level of calprotectin andinflammation in a subject in need thereof. In an aspect, the presentdisclosure provides a method for reducing the level of calprotectin in asubject in need thereof by at least 10% compared to the calprotectinlevel prior to treatment. In another aspect, the level of calprotectinis reduced by at least 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%,70%, 75%, 80%, 85%, 90%, or 95%. In another aspect, the level ofcalprotectin is reduced by between 2 and 10%, 10 and 20%, 20 and 30%, 30and 40%, 40 and 50%, 50 and 60%, 60 and 70%, 70 and 80%, 80 and 85%, 85and 90%, 90 and 95%, and 95 and 99% compared to the calprotectin levelprior to treatment. In a further aspect, the level of calprotectin isreduced to below 100 μg/g, below 90 μg/g, below 80 μg/g, below 70 μg/g,below 60 μg/g, below 65 μg/g, below 55 μg/g, below 50 μg/g, below 45μg/g, below 40 μg/g, or below 35 μg/g. In another aspect, the level ofcalprotectin is reduced in a subject in need thereof following atreatment regimen lasting for at least 8 weeks. In another aspect, thelevel of calprotectin is reduced in a subject in need thereof at 8 weeksafter the completion of the treatment regimen. In yet another aspect,the level of calprotectin is reduced in a subject in need thereofbetween 1 and 12 weeks, between 2 and 12 weeks, between 3 and 12 weeks,between 4 and 12 weeks, between 5 and 12 weeks, between 6 and 12 weeks,between 7 and 12 weeks, between 8 and 12 weeks, between 9 and 12 weeks,between 10 and 12 weeks, between 1 and 2 weeks, between 2 and 3 weeks,between 3 and 4 weeks, between 4 and 5 weeks, between 5 and 6 weeks,between 6 and 7 weeks, between 7 and 8 weeks, between 8 and 9 weeks,between 9 and 10 weeks, or between 10 and 11 weeks after the completionof the treatment regimen. In a further aspect, the level of calprotectinis reduced in a subject in need thereof between 12 and 30 weeks, between12 and 28 weeks, between 12 and 20 weeks, between 14 and 20 weeks,between 14 and 26 weeks, between 12 and 18 weeks, between 12 and 16weeks, between 20 and 30 weeks, between 25 and 30 weeks, and between 21and 27 weeks after the completion of the treatment regimen. In anotheraspect, the level of calprotectin is reduced in a subject in needthereof after 1 or more, 2 or more, 3 or more, 4 or more, 5 or more, 6or more, 7 or more, 8 or more, 9 or more, 10 or more, 11 or more, 12 ormore, 13 or more, 14 or more, 15 or more, 16 or more, 18 or more, 20 ormore, 22 or more, 24 or more, 26 or more, 28 or more, 30 or more, 40 ormore, 50 or more weeks after the completion of the treatment regimen.

In one aspect, the present disclosure provides a method for treatingulcerative colitis in a subject in need thereof, where the methodcomprises treating said patient with a treatment regimen comprising theadministration of a pharmaceutical composition comprising livenon-pathogenic fecal bacteria for at least 8 weeks and at least threetimes per week. In another aspect, any method or treatment regimenprovided here can also be used to treat one or more indications selectedfrom the group consisting of collagenous colitis, lymphocytic colitis,Crohn's colitis, diverticulitis, and pouchitis.

In an aspect, this disclosure provides a method for treating ulcerativecolitis in a subject in need thereof and exhibiting a Mayo endoscopyscore of 3 or lower, where the method comprises administering to saidsubject a pharmaceutical composition comprising live non-pathogenicfecal bacteria. In one aspect, this administering is following atreatment regimen lasting for at least 8 weeks. In an aspect, thisadministering is following a treatment regimen of at least 8 weeks andat least three time per week. In one aspect, this administering isfollowing a treatment regimen of at least 8 weeks and at least threetimes per week.

In an aspect, the present disclosure provides a method for treatingulcerative colitis in a subject in need thereof, where the methodcomprises administering to the subject a pharmaceutical compositioncomprising live non-pathogenic fecal bacteria, where the subject has noconcomitant corticosteroid use during the method and has nocorticosteroid use immediately prior to commencing the method. In oneaspect, this administering is following a regimen lasting for at least 9weeks. In an aspect, this administering is following a regimen of atleast 8 weeks and at least three times per week.

In an aspect, the subject of the present disclosure exhibits a Mayoscore of at least 4 prior to treatment, such as a Mayo score of 4, 5, 6,7, 8, 9, 10. In one aspect, the subject of the present disclosureexhibits a Mayo score of 4 to 10 prior to treatment, such as 4 to 9, 5to 10, 5 to 8, or 6 to 8.

In an aspect, the subject of the present disclosure exhibits an UCEISscore of at least 4 prior to treatment, such as an UCEIS score of 4, 5,6, 7, 8, 9, 10. In one aspect, the subject of the present disclosureexhibits a UCEIS score of 4 to 10 prior to treatment, such as 4 to 9, 5to 10, 5 to 8, or 6 to 8.

In one aspect, the subject of the present disclosure is capable ofachieving a primary outcome at the end of a treatment regimen, where theprimary outcome is defined as a steroid-free clinical remission andendoscopic remission or response at the end of the treatment regimen,where the steroid free clinical remission is defined as a total Mayoscore of 2 or lower with sub-scores of 1 or lower, and where theendoscopic remission or response is defined as a reduction of at least 1point from baseline in endoscopy score. In another aspect, the subjectof the present disclosure is capable of achieving a primary outcome atthe end of a treatment regimen, where the primary outcome is defined asa steroid-free clinical remission which is defined as a total Mayo scoreof 2 or lower with sub-scores of 1 or lower. In a further aspect, thesubject of the present disclosure is capable of achieving a primaryoutcome at the end of a treatment regimen, where the primary outcome isdefined as a steroid-free endoscopic remission or response which isdefined as a reduction of at least 1 point from baseline in endoscopyscore.

In an aspect, a subject of the present disclosure has no steroid usewithin at least one week prior to commencing the methods providedherein. In another aspect, a subject of the present disclosure has nosteroid use within at least two, three, four, or five weeks prior tocommencing the methods provided herein. In a further aspect, a subjectof the present disclosure has no steroid use within at least 1, 2, 3, 4,5, 6, 7, 8, 9, 10, 11, 12, 13, or 14 days prior to commencing themethods provided herein. In one aspect, a steroid may be prednisone,budesonide, or hydrocortisone. In an aspect, a subject of the presentdisclosure has no corticosteroid use within at least one week prior tocommencing the methods provided herein. In one aspect, a subject of thepresent disclosure has no corticosteroid use prior to commencing themethods provided herein.

In some aspects, the methods of the present disclosure further comprisedetermining the subject's baseline gut bacterial diversity. In anaspect, a subject's baseline gut bacterial diversity is assessed byanalyzing Shannon's diversity of the subject's fecal sample prior to thetreating step. In one aspect, a subject's baseline fecal Shannondiversity is between 0.5 and 2.2 based on bacterial species level, suchas between 0.5 and 2.0, between 1.0 and 2.2, or between 1.0 and 1.5. Inan aspect, a subject's fecal Shannon diversity increases by at least50%, 60%, 70%, 80%, 90%, 95%, 98%, 99%, 99.5%, 99.8%, or 99.9% comparedto before treatment. In one aspect, a subject's fecal Shannon diversityincreases by at least 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 15, 20, or 30folds compared to before treatment. In one aspect, a subject'spost-treatment fecal Shannon diversity is between 1.5 and 6.0 based onbacterial species level, such as between 1.5 and 5.0, between 1.5 and4.5, between 1.5 and 4.0, between 1.5 and 3.5, between 1.5 and 3.0,between 1.5 and 2.5, between 1.5 and 2.0, between 2.0 and 4.5, between2.5 and 4.0, between 3.0 and 3.5, between 2.0 and 6.0, between 2.5 and6.0, between 3.0 and 6.0, between 3.5 and 6.0, between 4.0 and 6.0,between 4.5 and 6.0, between 5.0 and 6.0, and between 5.5 and 6.0.

In certain aspects, the methods of the present disclosure furthercomprise determining the level of Fusobacterium, Sutterella, or both ina subject's gut. In some aspects, methods of the present disclosurefurther comprise determining the level of one or more bacteria selectedfrom the group consisting of Barnesiella, Parabacteroides, ClostridiumIV, Ruminococcus, Blautia, Dorea, Ruminococcus2, and Clostridium XVIIIin the subject's gut.

In an aspect, the present disclosure provides a treatment regimen thatis capable of achieving a primary outcome rate of at least two foldhigher relative to a primary outcome rate from placebo, where theprimary outcome is defined as a steroid-free clinical remission andendoscopic remission or response at the end of the treatment regimen,where the clinical remission is defined as a total Mayo score of 2 orlower with all sub-scores of 1 or lower, and where the endoscopicremission or response is defined as a reduction of at least 1 point frombaseline in Mayo endoscopy score. In one aspect, the present disclosureprovides a treatment regimen that is capable of achieving a primaryoutcome rate higher than a primary outcome rate from placebo, where theprimary outcome is defined as a steroid-free clinical remission andendoscopic remission or response at the end of the treatment regimen,where the clinical remission is defined as a total Mayo score of 2 orlower with all sub-scores of 1 or lower, and where the endoscopicremission or response is defined as a reduction of at least 1 point frombaseline in Mayo endoscopy score.

In one aspect, a treatment regimen in accordance with the presentdisclosure is capable of achieving a primary outcome rate of at least25%, such as at least 20%, at least 35%, at least 40%, at least 45%, atleast 50%, at least 55%, at least 60%, at least 65%, at least 70%, atleast 75%, at least 80%, at least 85%, at least 90%, at least 95%, atleast 98%, at least 99%, at least 99.5%, or at least 99.9%. In anaspect, a treatment regimen is capable of achieving a primary outcomerate of between 20% to 40%, such as between 20% and 35%, between 25% and40%, between 25% and 35%, between 25% and 30%, or between 30% and 35%.

In one aspect, a treatment regimen in accordance with the presentdisclosure is capable of achieving a clinical remission sustaining rateof at least 40% at 8 weeks after the completion of the treatmentregimen. In an aspect, a treatment regimen is capable of achieving aclinical remission sustaining rate of at least 45%, such as at least50%, at least 55%, at least 60%, at least 65%, at least 70%, at least75%, at least 80%, at least 85%, at least 90%, at least 95%, at least98%, at least 99%, at least 99.5%, or at least 99.9% at 8 weeks afterthe completion of the treatment regimen. In an aspect, a treatmentregimen is capable of achieving a clinical remission sustaining rate ofbetween 35% and 60%, such as between 35% and 55%, between 40% and 60%,between 40% and 55%, between 40% and 50%, between 45% and 55%, orbetween 45% and 50% at 8 weeks after the completion of the treatmentregimen.

In one aspect, a treatment regimen in accordance with the presentdisclosure is capable of achieving a steroid-free clinical remissionrate of at least two fold higher relative to a steroid-free clinicalremission rate from placebo, where the clinical remission is defined asa combined Mayo score of 1 or lower for rectal bleeding and stoolfrequency. In an aspect, a treatment regimen in accordance with thepresent disclosure is capable of achieving a steroid-free clinicalremission rate higher than a steroid-free clinical remission rate fromplacebo, where the clinical remission is defined as a combined Mayoscore of 1 or lower for rectal bleeding and stool frequency. In anaspect, a treatment regimen is capable of achieving a steroid-freeclinical remission rate of at least 40%, such as at least 45%, at least50%, at least 55%, at least 60%, at least 65%, at least 70%, at least75%, at least 80%, at least 85%, at least 90%, at least 95%, at least98%, at least 99%, at least 99.5%, or at least 99.9%. In one aspect, atreatment regimen is capable of achieving a steroid-free clinicalremission rate of between 35% and 55%, such as between 40% and 55%,between 35% and 50%, between 40% and 50%, between 40% and 45%, orbetween 45% and 50%.

In an aspect, a treatment regimen in accordance with the presentdisclosure is capable of achieving a steroid-free clinical response rateof at least two fold higher relative to a steroid-free clinical responserate from placebo, where the clinical response is defined as a totalMayo score decrease of 3 or higher or a 50% higher reduction frombaseline in combined score for rectal bleeding and stool frequency. Inone aspect, a treatment regimen in accordance with the presentdisclosure is capable of achieving a steroid-free clinical response ratehigher than a steroid-free clinical response rate from placebo, wherethe clinical response is defined as a total Mayo score decrease of 3 orhigher or a 50% higher reduction from baseline in combined score forrectal bleeding and stool frequency. In one aspect, a treatment regimenis capable of achieving a steroid-free clinical response rate of atleast 50%, such as at least 55%, at least 60%, at least 65%, at least70%, at least 75%, at least 80%, at least 85%, at least 90%, at least95%, at least 98%, at least 99%, at least 99.5%, or at least 99.9%. Inan aspect, a treatment regimen in accordance with the present disclosureis capable of achieving a steroid-free clinical response rate between45% and 65%, such as between 45% and 60%, between 50% and 65%, between50% and 60%, between 50% and 55%, or between 55% and 60%.

In one aspect, a treatment regimen in accordance with the presentdisclosure is capable of achieving an endoscopic response rate of atleast two fold higher relative to an endoscopic response rate fromplacebo, where the endoscopic response is defined as a total UCEIS scoredecrease of 3 or higher or a 50% or higher reduction from baseline. Inone aspect, a treatment regimen in accordance with the presentdisclosure is capable of achieving an endoscopic response rate higherthan an endoscopic response rate from placebo, where the endoscopicresponse is defined as a total UCEIS score decrease of 3 or higher or a50% or higher reduction from baseline. In an aspect, a treatment regimenis capable of achieving an endoscopic rate of at least 30%, such as atleast 35%, at least 40%, at least 45%, at least 50%, at least 55%, atleast 60%, at least 65%, at least 70%, at least 75%, at least 80%, atleast 85%, at least 90%, at least 95%, at least 98%, at least 99%, atleast 99.5%, or at least 99.9%. In one aspect, a treatment regimen iscapable of achieving an endoscopic response rate between 30% and 45%,such as between 30% and 40%, between 35% and 45%, or between 35% and40%.

In one aspect, the present disclosure provides a method for treatingulcerative colitis in a subject in need thereof, where the methodcomprises administering to the subject a pharmaceutically active dose ofa therapeutic composition comprising live non-pathogenic fecal bacteria.In another aspect, this disclosure provides use of a compositioncomprising live non-pathogenic fecal bacteria in the manufacture of amedication for the treatment of ulcerative colitis.

In some aspects, methods of the present disclosure treat a form ofulcerative colitis selected from the group consisting of ulcerativeproctitis, proctosigmoiditis, left-sided colitis, and pan-ulcerativecolitis. In an aspect, a pharmaceutical composition in accordance withthe present disclosure comprises a fecal microbiota preparation. In oneaspect, a pharmaceutical composition comprises an isolated or purifiedpopulation of live non-pathogenic fecal bacteria. In an aspect, apharmaceutical composition comprises a non-selective fecal microbiota.In one aspect, a pharmaceutical composition comprises a non-selected andsubstantially complete fecal microbiota. In an aspect, a pharmaceuticalcomposition comprises a full-spectrum fecal microbiota. In one aspect, amethod further comprises administering a 5-aminosalicylic acid agent, acorticosteroid, an immunosuppressant, or a combination thereof. Inanother aspect, a method further comprises administering5-aminosalicylic acid or a derivative thereof, sulfasalazine or aderivative thereof, or a combination thereof.

In one aspect, the present disclosure provides a method for selecting atreatment plan for treating ulcerative colitis in a subject in needthereof, where the method comprises determining the level ofFusobacterium, Sutterella, or both in the subject's gut; andrecommending a fecal bacteria-based therapy when the level ofFusobacterium, Sutterella, or both is above a predetermined level. In anaspect, the level of Fusobacterium, Sutterella, or both is about 8%above a predetermined level, such as about 10%, about 15%, about 20%,about 25%, about 30%, about 35%, about 40%, about 45%, about 50%, about55%, about 60%, about 65%, about 70%, about 75%, about 80%, about 85%,about 90%, about 95%, about 100%, about 150%, or about 200% above apredetermined level. In an aspect, the present disclosure provides amethod for selecting a treatment plan for treating ulcerative colitis ina subject in need thereof, where the method comprises determining thelevel of Fusobacterium, Sutterella, or both in said subject's gut; andrecommending a fecal bacteria-based therapy when said level ofFusobacterium, Sutterella, or both is between a predetermined range. Inone aspect, the predetermined range is about 8% to about 50% above apredetermined level, such as about 8% to about 40%, about 10% to 50%,about 15% to about 40%, about 20% to about 35%, or about 25% to about30% above a predetermined level. In an aspect, the predetermined rangeis about 50% to about 200% above a predetermined level, such as about50% to about 150%, about 50% to about 100%, about 100% to 150%, about80% to about 120%, about 90% to about 110%, or about 98% to about 100%above a predetermined level. In some aspects, the level of one or morebacteria is determined via analyzing a subject's feces.

In an aspect, the present disclosure provides a method for selecting atreatment plan for treating ulcerative colitis in a subject in needthereof, where the method comprises determining the level of one or morebacteria selected from the group consisting of Barnesiella,Parabacteroides, Clostridium IV, Ruminococcus, Blautia, Dorea,Ruminococcus2, and Clostridium XVIII in said subject's gut; andrecommending a fecal bacteria-based therapy when the level of the one ormore selected bacteria is above a predetermined level. In an aspect, thelevel of the one or more selected bacteria is about 8% above apredetermined level, such as about 10%, about 15%, about 20%, about 25%,about 30%, about 35%, about 40%, about 45%, about 50%, about 55%, about60%, about 65%, about 70%, about 75%, about 80%, about 85%, about 90%,about 95%, about 100%, about 150%, or about 200% above a predeterminedlevel. In an aspect, the present disclosure provides a method forselecting a treatment plan for treating ulcerative colitis in a subjectin need thereof, where the method comprises determining the level of oneor more bacteria selected from the group consisting of Barnesiella,Parabacteroides, Clostridium IV, Ruminococcus, Blautia, Dorea,Ruminococcus2, and Clostridium XVIII in said subject's gut; andrecommending a fecal bacteria-based therapy when the level of the one ormore selected bacteria is between a predetermined range. In one aspect,the predetermined range is about 8% to about 50% above a predeterminedlevel, such as about 8% to about 40%, about 10% to 50%, about 15% toabout 40%, about 20% to about 35%, or about 25% to about 30% above apredetermined level. In an aspect, the predetermined range is about 50%to about 200% above a predetermined level, such as about 50% to about150%, about 50% to about 100%, about 100% to 150%, about 80% to about120%, about 90% to about 110%, or about 98% to about 100% above apredetermined level. In some aspects, the level of one or more bacteriais determined via analyzing a subject's feces.

In one aspect, a predetermined level is established by the correspondinglevel of the one or more selected bacteria in healthy subjects. In anaspect, a predetermined level is established by the corresponding levelof the one or more selected bacteria in healthy subjects in the samedemographic category as the subject. In one aspect, a predeterminedlevel is established by the abundance of the total Clostridium orBacteriodetes population in the same subject.

In one aspect, the present disclosure provides a method which eliminatesor reduces one or more ulcerative colitis symptoms selected from thegroup consisting of diarrhea, cramp, tenesmus, weight loss, bleeding,loss of appetite, abdominal pain, fever, fatigue, anaemia, inflammation,and micro-ulcers.

In one aspect, the present disclosure provides a method for treatingulcerative colitis in a subject in need thereof, where the methodcomprises administering to the subject a pharmaceutically active dose ofa therapeutic composition comprising live non-pathogenic bacteria. Inone aspect, the present disclosure provides a method for treatingulcerative colitis in a subject in need thereof, where the methodcomprises administering daily to the subject a pharmaceutically activedose of a therapeutic composition comprising live non-pathogenic fecalbacteria. In one aspect, a therapeutic composition is administered to anulcerative colitis patient in need thereof at least once daily for atleast two consecutive days. In one aspect, a therapeutic composition isadministered at least once daily for at least 3, 4, 5, 6, 7, 8, 9, 10,11, 12, 13, 14, or 15 consecutive days. In another aspect, a therapeuticcomposition is administered at least once daily for at least 1, 2, 3, 4,5, 6, 7, 8, 9, 10, 11, or 12 consecutive weeks. In one aspect, atherapeutic composition is administered at least once daily for at most4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, or 20consecutive days or weeks. In another aspect, a therapeutic compositionis administered at least once daily for at most 1, 2, 3, 4, 5, 6, 7, 8,9, 10, 11, or 12 consecutive weeks or months. In a further aspect, atherapeutic composition is administered at least once for at least 1, 2,3, 4, 5, 6, 7, 8, 9, 10, 11, or 12 consecutive months or years,chronically for a subject's entire life span, or an indefinite period oftime.

In one aspect, a therapeutic composition is administered to anulcerative colitis patient in need thereof at least twice daily for atleast two consecutive days. In one aspect, a therapeutic composition isadministered at least twice daily for at least 3, 4, 5, 6, 7, 8, 9, 10,11, 12, 13, 14, or 15 consecutive days. In another aspect, a therapeuticcomposition is administered at least twice daily for at least 1, 2, 3,4, 5, 6, 7, 8, 9, 10, 11, or 12 consecutive weeks. In one aspect, atherapeutic composition is administered at least twice daily for at most4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, or 20consecutive days or week. In another aspect, a therapeutic compositionis administered at least twice daily for at most 1, 2, 3, 4, 5, 6, 7, 8,9, 10, 11, or 12 consecutive weeks or months. In a further aspect, atherapeutic composition is administered at least twice for at least 1,2, 3, 4, 5, 6, 7, 8, 9, 10, 11, or 12 consecutive months or years,chronically for a subject's entire life span, or an indefinite period oftime.

In one aspect, a therapeutic composition is administered to anulcerative colitis patient in need thereof at least three times dailyfor at least two consecutive days. In one aspect, a therapeuticcomposition is administered at least three times daily for at least 3,4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, or 15 consecutive days. In anotheraspect, a therapeutic composition is administered at least three timesdaily for at least 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, or 12 consecutiveweeks. In one aspect, a therapeutic composition is administered at leastthree times daily for at most 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15,16, 17, 18, 19, or 20 consecutive days or weeks. In another aspect, atherapeutic composition is administered at least three times daily forat most 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, or 12 consecutive weeks ormonths. In a further aspect, a therapeutic composition is administeredat least three times for at least 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, or12 consecutive months or years, chronically for a subject's entire lifespan, or an indefinite period of time.

In one aspect, the present disclosure provides a method for treatingulcerative colitis in a subject in need thereof, where the methodcomprises administering orally to the subject a pharmaceutically activedose of a therapeutic composition comprising live, non-pathogenic,synthetic bacterial mixture or live, non-pathogenic, purified orextracted, fecal microbiota, where the dose is administered at a dosingschedule of at least once or twice daily for at least three consecutivedays or weeks. In another aspect, a dose is administered at least once,twice, or three times daily for a period between 1 and 12 weeks, between2 and 12 weeks, between 3 and 12 weeks, between 4 and 12 weeks, between5 and 12 weeks, between 6 and 12 weeks, between 7 and 12 weeks, between8 and 12 weeks, between 9 and 12 weeks, between 10 and 12 weeks, between1 and 2 weeks, between 2 and 3 weeks, between 3 and 4 weeks, between 4and 5 weeks, between 5 and 6 weeks, between 6 and 7 weeks, between 7 and8 weeks, between 8 and 9 weeks, between 9 and 10 weeks, or between 10and 11 weeks.

In one aspect, the present disclosure provides a method for treatingulcerative colitis in a subject in need thereof, where the methodcomprises a first dosing schedule followed by a second dosing schedule.In one aspect, a first dosing schedule comprises a treatment orinduction dose. In one aspect, a first dosing schedule comprises acontinuous dosing schedule. In another aspect, a second dosing schedulecomprises a maintenance dose lower than or equal to a pharmaceuticallyactive dose of a first dosing schedule. In another aspect, a seconddosing schedule lasts for at least about 2, 4, 6, 8, 10, 12, 18, 24, 36,48, 72, or 96 months. In one aspect, a second dosing schedule lastspermanently, for a treated subject's entire life span, or an indefiniteperiod of time. In one aspect, a second dosing schedule is a continuousdosing schedule. In another aspect, a second dosing schedule is anintermittent dosing schedule. In a further aspect, a second dosingschedule is an intermittent dosing schedule comprising a treatmentperiod of at least 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, or 14 daysfollowed by a resting period of at least 1, 2, 3, 4, 5, 6, 7, 8, 9, 10,11, 12, 13, or 14 days. In another aspect, a second dosing schedulecomprises administering a second dose (e.g., a maintenance dose) everyother day, every two days, or every 3, 4, 5, 6, 7, 8 days. In anotheraspect, a maintenance dose is administered for an extended period oftime with or without titration (or otherwise changing the dosage ordosing schedule). In one aspect, the interval between a first and asecond dosing schedule is at least about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10,11, or 12 weeks. In another aspect, a second dosing schedule (e.g., amaintenance dose) comprises a dosage about 2, 5, 10, 50, 100, 200, 400,800, 1000, 5000 or more folds lower than the dosage used in a firstdosing schedule (e.g., an initial treatment dose). In another aspect, asecond dosing schedule (e.g., a maintenance dosing schedule) has anequal or lower dosing frequency than a first dosing schedule (e.g., aninitial treatment dosing schedule). In another aspect, a second dosingschedule (e.g., a maintenance dosing schedule) has a higher dosinginterval than a first dosing schedule (e.g., an initial treatment dosingschedule).

In one aspect, a first or second dosing schedule used in a method can beonce-a-week, twice-a-week, or thrice-a-week. The term “once-a-week”means that a dose is administered once in a week, preferably on the sameday of each week. “Twice-a-week” means that a dose is administered twotimes in a week, preferably on the same two days of each weekly period.“Thrice-a-week” means that a dose is administered three times in a week,preferably on the same three days of each weekly period.

In one aspect, a subject being treated is a subject already withulcerative colitis. Administration of a disclosed therapeuticcomposition to clinically, asymptomatic human subject who is geneticallypredisposed or prone to ulcerative colitis is also useful in preventingthe onset of clinical symptoms of ulcerative colitis. A human subjectgenetically predisposed or prone to ulcerative colitis can be a humansubject having a close family member or relative exhibiting or havingsuffered ulcerative colitis. In another aspect, a subject being treatedis a subject in which ulcerative colitis is to be prevented. In anotheraspect, a subject being treated is predisposed or susceptible toulcerative colitis. In another aspect, a subject being treated is asubject diagnosed as having ulcerative colitis. In one aspect, a subjectbeing treated is a patient in need thereof.

In one aspect, a subject being treated is a human patient. In oneaspect, a patient is a male patient. In one aspect, a patient is afemale patient. In one aspect, a patient is a premature newborn. In oneaspect, a patient is a term newborn. In one aspect, a patient is aneonate. In one aspect, a patient is an infant. In one aspect, a patientis a toddler. In one aspect, a patient is a young child. In one aspect,a patient is a child. In one aspect, a patient is an adolescent. In oneaspect, a patient is a pediatric patient. In one aspect, a patient is ageriatric patient. In one aspect, a human patient is a child patientbelow about 18, 15, 12, 10, 8, 6, 4, 3, 2, or 1 year old. In anotheraspect, a human patient is an adult patient. In another aspect, a humanpatient is an elderly patient. In a further aspect, a human patient is apatient above about 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90,or 95 years old. In another aspect, a patient is about between 1 and 5,between 2 and 10, between 3 and 18, between 21 and 50, between 21 and40, between 21 and 30, between 50 and 90, between 60 and 90, between 70and 90, between 60 and 80, or between 65 and 75 years old. In oneaspect, a patient is a young old patient (65-74 years). In one aspect, apatient is a middle old patient (75-84 years). In one aspect, a patientis an old patient (>85 years).

In one aspect, a method comprises administering a therapeuticcomposition orally, by enema, or via rectal suppository. In one aspect,a therapeutic composition administered herein is formulated as anenteric coated (and/or acid-resistant) capsule or microcapsule, orformulated as part of or administered together with a food, a foodadditive, a dairy-based product, a soy-based product or a derivativethereof, a jelly, or a yogurt. In another aspect, a therapeuticcomposition administered herein is formulated as an acid-resistantenteric coated capsule. A therapeutic composition can be provided as apowder for sale in combination with a food or drink. A food or drink canbe a dairy-based product or a soy-based product. In another aspect, afood or food supplement contains enteric-coated and/or acid-resistantmicrocapsules containing a therapeutic composition.

In an aspect, a therapeutic composition comprises a liquid culture. Inanother aspect, a therapeutic composition is lyophilized, pulverized andpowdered. It may then be infused, dissolved such as in saline, as anenema. Alternatively the powder may be encapsulated as enteric-coatedand/or acid-resistant capsules for oral administration. These capsulesmay take the form of enteric-coated and/or acid-resistant microcapsules.A powder can preferably be provided in a palatable form forreconstitution for drinking or for reconstitution as a food additive. Ina further aspect, a food is yogurt. In one aspect, a powder may bereconstituted to be infused via naso-duodenal infusion.

In another aspect, a therapeutic composition administered herein is in aliquid, frozen, freeze-dried, spray-dried, lyophilized, or powder form.In a further aspect, a therapeutic composition administered herein isformulated as a delayed or gradual enteric release form. In anotheraspect, a therapeutic composition administered herein comprises anexcipient, a saline, a buffer, a buffering agent, or afluid-glucose-cellobiose agar (RGCA) media. In another aspect, atherapeutic composition administered herein comprises a cryoprotectant.In one aspect, a cryoprotectant comprises polyethylene glycol, skimmilk, erythritol, arabitol, sorbitol, glucose, fructose, alanine,glycine, proline, sucrose, lactose, ribose, trehalose, dimethylsulfoxide (DMSO), glycerol, or a combination thereof.

In one aspect, a therapeutic composition administered herein furthercomprises an acid suppressant, an antacid, an H2 antagonist, a protonpump inhibitor or a combination thereof. In one aspect, a therapeuticcomposition administered herein substantially free of non-living matter.In another aspect, a therapeutic composition administered hereinsubstantially free of acellular material selected from the groupconsisting of residual fiber, DNA, viral coat material, and non-viablematerial.

In one aspect, a therapeutic composition also comprises or issupplemented with a prebiotic nutrient selected from the groupconsisting of polyols, fructooligosaccharides (FOSs), oligofructoses,inulins, galactooligosaccharides (GOSs), xylooligosaccharides (XOSs),polydextroses, monosaccharides, tagatose, and/or mannooligosaccharides.

In one aspect, a method further comprises pretreating a subject with anantibiotic composition prior to administering a therapeutic bacterial ormicrobiota composition. In one aspect, an antibiotic compositionadministered herein comprises an antibiotic selected from the groupconsisting of rifabutin, clarithromycin, clofazimine, vancomycin,rifampicin, nitroimidazole, chloramphenicol, and a combination thereof.In another aspect, an antibiotic composition administered hereincomprises an antibiotic selected from the group consisting of rifaximin,rifamycin derivative, rifampicin, rifabutin, rifapentine, rifalazil,bicozamycin, aminoglycoside, gentamycin, neomycin, streptomycin,paromomycin, verdamicin, mutamicin, sisomicin, netilmicin, retymicin,kanamycin, aztreonam, aztreonam macrolide, clarithromycin,dirithromycin, roxithromycin, telithromycin, azithromycin, bismuthsubsalicylate, vancomycin, streptomycin, fidaxomicin, amikacin,arbekacin, neomycin, netilmicin, paromomycin, rhodostreptomycin,tobramycin, apramycin, and a combination thereof. In a further aspect, amethod further comprises pretreating a subject with an anti-inflammatorydrug prior to administration of a therapeutic bacterial or microbiotacomposition.

In one aspect, a method achieves a remission, cure, response, orresolution rate of ulcerative colitis of at least about 10%, 15%, 20%,25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%,95%, 97%, or 99%. In one aspect, a treatment method achieves a reductionof ulcerative colitis disease activity index (UCDAI) after 8 weeks oftreatment by more than 2, 3, 4, 5, 6, 7, 8, 9, 10, or 11. In anotheraspect, a treatment method achieves a reduction of ulcerative colitisdisease activity index (UCDAI) after 8 weeks of treatment by more than2, 3, 4, 5, 6, 7, 8, 9, 10, or 11 in at least 10%, 20%, 30%, 50%, 60%,70%, 80%, or 90% patients in a patient population. In one aspect, atreatment method achieves at least 10%, 20%, 30%, 50%, 60%, 70%, 80%, or90% reduction of ulcerative colitis disease activity index (UCDAI) after8 weeks of treatment compared to baseline (e.g., immediately prior totreatment). In one aspect, a treatment method achieves at least 10%,20%, 30%, 50%, 60%, 70%, 80%, or 90% reduction of ulcerative colitisdisease activity index (UCDAI) in at least 10%, 20%, 30%, 50%, 60%, 70%,80%, or 90% patients after 8 weeks of treatment compared to baseline(e.g., immediately prior to treatment).

In a further aspect, a patient is assessed using the Disease ActivityIndex (DAI) or Mayo score system as described in Schroeder et al.,Coated oral 5-aminosalicylic acid therapy for mildly to moderatelyactive ulcerative colitis. N Eng J Med. 1987; 317:1625-1629. In oneaspect, a treatment method achieves at least 10%, 20%, 30%, 50%, 60%,70%, 80%, or 90% reduction of Mayo score after 8 weeks of treatmentcompared to baseline (e.g., immediately prior to treatment). In oneaspect, a treatment method achieves at least 10%, 20%, 30%, 50%, 60%,70%, 80%, or 90% reduction of Mayo score in at least 10%, 20%, 30%, 50%,60%, 70%, 80%, or 90% patients after 8 weeks of treatment compared tobaseline (e.g., immediately prior to treatment).

In one aspect, a pharmaceutically active or therapeutic effective dosecomprises at least about 10⁵, 10⁶, 10⁷, 10⁸, 10⁹, 10¹⁰, 10¹¹, 10¹², or10¹³ cfu. In another aspect, a pharmaceutically active therapeuticeffective dose comprises at most about 10⁵, 10⁶, 10⁷, 10⁸, 10⁹, 10¹⁰,10¹¹, 10¹², or 10¹³ cfu. In a further aspect, a pharmacologically activetherapeutic effective dose is selected from the group consisting of from10⁸ cfu to 10¹⁴ cfu, from 10⁹ cfu to 10¹³ cfu, from 10¹⁰ cfu to 10¹²cfu, from 10⁹ cfu to 10¹⁴ cfu, from 10⁹ cfu to 10¹² cfu, from 10⁹ cfu to10¹¹ cfu, from 10⁹ cfu to 10¹⁰ cfu, from 10¹⁰ cfu to 10¹⁴ cfu, from 10¹⁰cfu to 10¹³ cfu, from 10¹¹ cfu to 10¹⁴ cfu, from 10¹¹ cfu to 10¹³ cfu,from 10¹² cfu to 10¹⁴ cfu, and from 10¹³ cfu to 10¹⁴ cfu.

In one aspect, a pharmaceutically active or therapeutic effective dosecomprises at least about 10⁵, 10⁶, 10⁷, 10⁸, 10⁹, 10¹⁰, 10¹¹, 10¹², or10¹³ cells or spores. In another aspect, a pharmaceutically active ortherapeutic effective dose comprises at most about 10⁵, 10⁶, 10⁷, 10⁸,10⁹, 10¹⁰, 10¹¹, 10¹², or 10¹³ total cells or spores. In a furtheraspect, a pharmacologically active or therapeutic effective dose isselected from the group consisting of from 10⁸ to 10¹⁴, from 10⁹ to 10¹³from 10¹⁰ to 10¹² from 10⁹ to 10¹⁴ from 10⁹ to 10¹² from 10⁹ to 10¹¹from 10⁹ to 10¹⁰, from 10¹⁰ to 10¹⁴, from 10¹⁰ to 10¹³, from 10¹¹ to10¹⁴, from 10¹¹ to 10¹³, from 10¹² to 10¹⁴, and from 10¹³ to 10¹⁴ cellsor spores. In an aspect, the pharmaceutically active or therapeuticeffective dose cell count is directed to live cells.

In one aspect, a therapeutic composition administered herein comprisesfecal bacteria. In one aspect, a therapeutic composition administeredherein comprises one or more, two or more, three or more, four or more,or five or more isolated, purified, or cultured microorganisms selectedfrom the group consisting of Clostridium, Bacillus, Collinsella,Bacteroides, Eubacterium, Fusobacterium, Propionibacterium,Lactobacillus, Ruminococcus, Escherichia coli, Gemmiger, Desulfomonas,Peptostreptococcus, Bifidobacterium, Coprococcus, Dorea, and Monilia.

In one aspect, a therapeutic composition administered herein comprisesat least one, at least two, at least three, at least four, at leastfive, at least six, or at least seven fecal microorganisms selected fromthe group consisting of a Bacteroides fragilis ssp. vulgatus,Collinsella aerofaciens, Bacteroides fragilis ssp. thetaiotaomicron,Peptostreptococcus productus II, Parabacteroides distasonis,Fusobacterium prausnitzii, Coprococcus eutactus, Collinsella aerofaciensIII, Peptostreptococcus productus I, Ruminococcus bromii,Bifidobacterium adolescentis, Gemmiger formicilis, Bifidobacteriumlongum, Eubacterium siraeum, Ruminococcus torques, Eubacterium rectale,Eubacterium eligens, Bacteroides eggerthii, Clostridium leptum,Bacteroides fragilis ssp. A, Eubacterium biforme, Bifidobacteriuminfantis, Eubacterium rectale Coprococcus comes, Pseudoflavonifractorcapillosus, Ruminococcus albus, Dorea fonnicigenerans, Eubacteriumhallii, Eubacterium ventriosum I, Fusobacterium russi, Ruminococcusobeum, Eubacterium rectale, Clostridium ramosum, Lactobacillusleichmannii, Ruminococcus callidus, Butyrivibrio crossotus,Acidaminococcus fermentans, Eubacterium ventriosum, Bacteroides fragilisssp. fragilis, Bacteroides AR, Coprococcus catus, Aerostipes hadrus,Eubacterium cylindroides, Eubacterium ruminantium, Eubacterium CH-1,Staphylococcus epidermidis, Peptostreptococcus BL, Eubacterium limosum,Tissirella praeacuta, Bacteroides L, Fusobacterium mortiferum I,Fusobacterium naviforme, Clostridium innocuum, Clostridium ramosum,Propionibacterium acnes, Ruminococcus flavefaciens, Ruminococcus AT,Peptococcus AU-1, Bacteroides fragilis ssp. ovatus, -ssp. d, -ssp. f;Bacteroides L-1, L-5; Fusobacterium nucleatum, Fusobacterium mortiferum,Escherichia coli, Gemella morbillorum, Finegoldia magnus, Peptococcus G,-AU-2; Streptococcus intermedius, Ruminococcus lactaris, Ruminococcus COGemmiger X, Coprococcus BH, -CC; Eubacterium tenue, Eubacterium ramulus,Bacteroides clostridiiformis ssp. clostridliformis, Bacteroidescoagulans, Prevotella oralis, Prevotella ruminicola, Odoribactersplanchnicus, Desuifomonas pigra, Lactobacillus G, Succinivibrio A, anda combination thereof.

In one aspect, a therapeutic composition administered herein comprisesno viable Bacteroides, Fusobacterium, Propionibacterium, Lactobacillus,Ruminococcus, Escherichia coli, Gemmiger, Desuifomonas,Peptostreptococcus, Bifidobacterium, Monilia, or any combinationthereof. In another aspect, a therapeutic composition administeredherein comprises no viable Bacteroides fragilis ssp. vulgatus,Collinsella aerofaciens, Bacteroides fragilis ssp. thetaiotaomicron,Peptostreptococcus productus II, Parabacteroides distasonis,Fusobacterium prausnitzii, Coprococcus eutactus, Collinsella aerofaciensIII, Peptostreptococcus productus I, Ruminococcus bromii,Bifidobacterium adolescentis, Gemmiger formicilis, Bifidobacteriumlongum, Eubacterium siraeum, Ruminococcus torques, Eubacterium rectale,Eubacterium eligens, Bacteroides eggerthii, Clostridium leptum,Bacteroides fragilis ssp. A, Eubacterium biforme, Bifidobacteriuminfantis, Eubacterium rectale III-F, Coprococcus comes,Pseudoflavonifractor capillosus, Ruminococcus albus, Doreaformicigenerans, Eubacterium hallii, Eubacterium ventriosum I,Fusobacterium russi, Ruminococcus obeum, Eubacterium rectale,Clostridium ramosum, Lactobacillus leichmannii, Ruminococcus callidus,Butyrivibrio crossotus, Acidaminococcus fermentans, Eubacteriumventriosum, Bacteroides fragilis ssp. fragilis, Bacteroides AR,Coprococcus catus, Aerostipes hadrus, Eubacterium cylindroides,Eubacterium ruminantium, Eubacterium CH-1, Staphylococcus epidermidis,Peptostreptococcus BL, Eubacterium limosum, Tissirella praeacuta,Bacteroides L, Fusobacterium mortiferum I, Fusobacterium naviforme,Clostridium innocuum, Clostridium ramosum, Propionibacterium acnes,Ruminococcus flavefaciens, Ruminococcus AT, Peptococcus AU-1,Bacteroides fragilis ssp. ovatus, -ssp. d, -ssp. f; Bacteroides L-1,L-5; Fusobacterium nucleatum, Fusobacterium mortiferum, Escherichiacoli, Gemella morbillorum, Finegoldia magnus, Peptococcus G, -AU-2;Streptococcus intermedius, Ruminococcus lactaris, Ruminococcus COGemmiger X, Coprococcus BH, -CC; Eubacterium tenue, Eubacterium ramulus,Bacteroides clostridiiformis ssp. clostridliformis, Bacteroidescoagulans, Prevotella oralis, Prevotella ruminicola, Odoribactersplanchnicus, Desuifomonas pigra, Lactobacillus G, Succinivibrio A, or acombination thereof.

In one aspect, a therapeutic composition administered herein comprises afecal microbiota. In another aspect, the preparation of a fecalmicrobiota used herein involves a treatment selected from the groupconsisting of ethanol treatment, detergent treatment, heat treatment,irradiation, and sonication. In another aspect, the preparation of afecal microbiota used herein involves no treatment selected from thegroup consisting of ethanol treatment, detergent treatment, heattreatment, irradiation, and sonication. In one aspect, the preparationof a fecal microbiota used herein involves a separation step selectedfrom the group consisting of density gradients, filtration (e.g.,sieves, nylon mesh), and chromatography. In another aspect, thepreparation of a fecal microbiota used herein involves no separationstep selected from the group consisting of density gradients, filtration(e.g., sieves, nylon mesh), and chromatography. In another aspect, afecal microbiota used herein comprises a donor's entire fecalmicrobiota. In another aspect, a therapeutic composition administeredherein comprises a fecal microbiota substantially free of eukaryoticcells from the fecal microbiota's donor.

In another aspect, a therapeutic composition administered hereincomprises a fecal microbiota further supplemented, spiked, or enhancedwith a fecal microorganism. In one aspect, a fecal microbiota issupplemented with a non-pathogenic (or with attenuated pathogenicity)bacterium of Clostridium, Collinsella, Dorea, Ruminococcus, Coprococcus,Prevotella, Veillonella, Bacteroides, Baccillus, or a combinationthereof. In another aspect, a therapeutic composition administeredherein comprises a fecal microbiota further supplemented, spiked, orenhanced with a species of Veillonellaceae, Firmicutes,Gammaproteobacteria, Bacteroidetes, or a combination thereof. In anotheraspect, a therapeutic composition administered herein comprises a fecalmicrobiota further supplemented with fecal bacterial spores. In oneaspect, fecal bacterial spores are Clostridium spores, Bacillus spores,or both.

In an aspect, a therapeutic composition comprises a fecal microbiotafrom a subject selected from the group consisting of a human, a bovine,a dairy calf, a ruminant, an ovine, a caprine, or a cervine. In anotheraspect, a therapeutic composition can be administered to a subjectselected from the group consisting of a human, a bovine, a dairy calf, aruminant, an ovine, a caprine, or a cervine. In an aspect, a therapeuticcomposition is substantially or nearly odourless.

In an aspect, a therapeutic composition provided or administered hereincomprises a fecal microbiota comprising a Shannon Diversity Index ofgreater than or equal to 0.3, greater than or equal to 0.4, greater thanor equal to 0.5, greater than or equal to 0.6, greater than or equal to0.7, greater than or equal to 0.8, greater than or equal to 0.9, greaterthan or equal to 1.0, greater than or equal to 1.1, greater than orequal to 1.2, greater than or equal to 1.3, greater than or equal to1.4, greater than or equal to 1.5, greater than or equal to 1.6, greaterthan or equal to 1.7, greater than or equal to 1.8, greater than orequal to 1.9, greater than or equal to 2.0, greater than or equal to2.1, greater than or equal to 2.2, greater than or equal to 2.3, greaterthan or equal to 2.4, greater than or equal to 2.5, greater than orequal to 3.0, greater than or equal to 3.1, greater than or equal to3.2, greater than or equal to 3.3, greater than or equal to 3.4, greaterthan or equal to 3.5, greater than or equal to 3.6, greater than orequal to 3.7, greater than or equal to 3.8, greater than or equal to3.9, greater than or equal to 4.0, greater than or equal to 4.1, greaterthan or equal to 4.2, greater than or equal to 4.3, greater than orequal to 4.4, greater than or equal to 4.5, or greater than or equal to5.0. In another aspect, a therapeutic composition comprises fecalmicrobiota comprising a Shannon Diversity Index of between 0.1 and 3.0,between 0.1 and 2.5, between 0.1 and 2.4, between 0.1 and 2.3, between0.1 and 2.2, between 0.1 and 2.1, between 0.1 and 2.0, between 0.4 and2.5, between 0.4 and 3.0, between 0.5 and 5.0, between 0.7 and 5.0,between 0.9 and 5.0, between 1.1 and 5.0, between 1.3 and 5.0, between1.5 and 5.0, between 1.7 and 5.0, between 1.9 and 5.0, between 2.1 and5.0, between 2.3 and 5.0, between 2.5 and 5.0, between 2.7 and 5.0,between 2.9 and 5.0, between 3.1 and 5.0, between 3.3 and 5.0, between3.5 and 5.0, between 3.7 and 5.0, between 31.9 and 5.0, or between 4.1and 5.0. In one aspect, a Shannon Diversity Index is calculated at thephylum level. In another aspect, a Shannon Diversity Index is calculatedat the family level. In one aspect, a Shannon Diversity Index iscalculated at the genus level. In another aspect, a Shannon DiversityIndex is calculated at the species level. In a further aspect, atherapeutic composition comprises a preparation of flora in proportionalcontent that resembles a normal healthy human fecal flora.

In a further aspect, a therapeutic composition comprises fecal bacteriafrom at least 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 different families. In afurther aspect, a therapeutic composition comprises fecal bacteria frommultiple donors. In an aspect, a therapeutic composition provided oradministered herein comprises a fecal microbiota comprising no greaterthan 0.05%, 0.1%, 0.2%, 0.3%, 0.4%, 0.5%, 0.6%, 0.7%, 0.8%, 0.9%, 1%,2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, or 10% weight non-living material/weightbiological material. In another aspect, a therapeutic compositionprovided or administered herein comprises a fecal microbiota comprisingno greater than 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%,75%, 80%, 85%, 90%, or 95% weight non-living material/weight biologicalmaterial. In another aspect, a therapeutic composition provided oradministered herein comprises, consists of, or consists essentially of,particles of non-living material and/or particles of biological materialof a fecal sample that passes through a sieve, a column, or a similarfiltering device having a sieve, exclusion, or particle filter size of2.0 mm, 1.0 mm, 0.5 mm, 0.25 mm, 0.212 mm, 0.180 mm, 0.150 mm, 0.125 mm,0.106 mm, 0.090 mm, 0.075 mm, 0.063 mm, 0.053 mm, 0.045 mm, 0.038 mm,0.032 mm, 0.025 mm, 0.020 mm, 0.01 mm, or 0.2 mm. “Non-living material”does not include an excipient, e.g., a pharmaceutically inactivesubstance, such as a cryoprotectant, added to a processed fecalmaterial. “Biological material” refers to the living material in fecalmaterial, and includes microbes including prokaryotic cells, such asbacteria and archaea (e.g., living prokaryotic cells and spores that cansporulate to become living prokaryotic cells), eukaryotic cells such asprotozoa and fungi, and viruses. In one embodiment, “biologicalmaterial” refers to the living material, e.g., the microbes, eukaryoticcells, and viruses, which are present in the colon of a normal healthyhuman. In an aspect, a therapeutic composition provided or administeredherein comprises an extract of human feces where the composition issubstantially odorless. In an aspect, a therapeutic composition providedor administered herein comprises fecal material or a fecal floralpreparation in a lyophilized, crude, semi-purified or purifiedformulation.

In an aspect, a fecal microbiota in a therapeutic composition compriseshighly refined or purified fecal flora, e.g., substantially free ofnon-floral fecal material. In an aspect, a fecal microbiota can befurther processed, e.g., to undergo microfiltration before, after, orbefore and after sieving. In another aspect, a highly purified fecalmicrobiota product is ultra-filtrated to remove large molecules butretain the therapeutic microflora, e.g., bacteria.

In another aspect, a fecal microbiota in a therapeutic composition usedherein comprises or consists essentially of a substantially isolated ora purified fecal flora or entire (or substantially entire) microbiotathat is (or comprises) an isolate of fecal flora that is at least about90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, 99.5%, 99.6%, 99.7%,99.8% or 99.9% isolated or pure, or having no more than about 0.1%,0.2%, 0.3%, 0.4%, 0.5%, 0.6%, 0.7%, 0.8%, 0.9% or 1.0% or more non-fecalfloral material; or, a substantially isolated, purified, orsubstantially entire microbiota as described in Sadowsky et al., WO2012/122478 A1, or as described in Borody et al., WO 2012/016287 A2.

In an aspect, a fecal microbiota in a therapeutic composition comprisesa donor's substantially entire or non-selective fecal microbiota,reconstituted fecal material, or synthetic fecal material. In anotheraspect, the fecal microbiota in a therapeutic composition comprises noantibiotic resistant population. In another aspect, a therapeuticcomposition comprises a fecal microbiota and is largely free ofextraneous matter (e.g., non-living matter including acellular mattersuch as residual fiber, DNA, RNA, viral coat material, non-viablematerial; and living matter such as eukaryotic cells from the fecalmatter's donor).

In an aspect, a fecal microbiota in a therapeutic composition usedherein is derived from disease-screened fresh homologous feces orequivalent freeze-dried and reconstituted feces. In an aspect, a freshhomologous feces does not include an antibiotic resistant population. Inanother aspect, a fecal microbiota in a therapeutic composition isderived from a synthetic fecal composition. In an aspect, a syntheticfecal composition comprises a preparation of viable flora whichpreferably in proportional content, resembles normal healthy human fecalflora which does not include antibiotic resistant populations. Suitablemicroorganisms may be selected from the following: Bacteroides,Eubacterium, Fusobacterium, Propionibacterium, Lactobacillus,Ruminococcus, Escherichia coli, Gemmiger, Clostridium, Desulfomonas,Peptostreptococcus, Bifidobacterium, Collinsella, Coprococcus, Dorea,and Ruminococcus.

In an aspect, a therapeutic composition is combined with other adjuvantssuch as antacids to dampen bacterial inactivation in the stomach. (e.g.,Mylanta, Mucaine, Gastrogel). In another aspect, acid secretion in thestomach could also be pharmacologically suppressed using H2-antagonistsor proton pump inhibitors. An example H2-antagonist is ranitidine. Anexample proton pump inhibitor is omeprazole. In one aspect, an acidsuppressant is administered prior to administering, or inco-administration with, a therapeutic composition.

In an aspect, a therapeutic composition is in the form of: an enemacomposition which can be reconstituted with an appropriate diluent;enteric-coated capsules; enteric-coated microcapsules; acid-resistanttablet; acid-resistant capsules; acid-resistant microcapsules; powderfor reconstitution with an appropriate diluent for naso-enteric infusionor colonoscopic infusion; powder for reconstitution with appropriatediluent, flavoring and gastric acid suppression agent for oralingestion; powder for reconstitution with food or drink; or food or foodsupplement comprising enteric-coated and/or acid-resistant microcapsulesof the composition, powder, jelly, or liquid.

In an aspect, a treatment method effects a cure, reduction of thesymptoms, or a percentage reduction of symptoms of ulcerative colitis.The change of flora is preferably as “near-complete” as possible and theflora is replaced by viable organisms which will crowd out anyremaining, original flora. Typically the change in enteric floracomprises introduction of an array of predetermined flora into thegastro-intestinal system, and thus in a preferred form the method oftreatment comprises substantially or completely displacing pathogenicenteric flora in patients requiring such treatment.

In another aspect, a therapeutic composition can be provided togetherwith a pharmaceutically acceptable carrier. As used herein, a“pharmaceutically acceptable carrier” refers to a non-toxic solvent,dispersant, excipient, adjuvant, or other material which is mixed with alive bacterium in order to permit the formation of a pharmaceuticalcomposition, e.g., a dosage form capable of administration to thepatient. A pharmaceutically acceptable carrier can be liquid (e.g.,saline), gel or solid form of diluents, adjuvant, excipients or an acidresistant encapsulated ingredient. Suitable diluents and excipientsinclude pharmaceutical grades of physiological saline, dextrose,glycerol, mannitol, lactose, starch, magnesium stearate, sodiumsaccharin, cellulose, magnesium carbonate, and the like, andcombinations thereof. In another aspect, a therapeutic composition maycontain auxiliary substances such as wetting or emulsifying agents,stabilizing or pH buffering agents. In an aspect, a therapeuticcomposition contains about 1%-5%, 5%-10%, 10%-15%, 15-20%, 20%-25%,25-30%, 30-35%, 40-45%, 50%-55%, 1%-95%, 2%-95%, 5%-95%, 10%-95%,15%-95%, 20%-95%, 25%-95%, 30%-95%, 35%-95%, 40%-95%, 45%-95%, 50%-95%,55%-95%, 60%-95%, 65%-95%, 70%-95%, 45%-95%, 80%-95%, or 85%-95% ofactive ingredient. In an aspect, a therapeutic composition containsabout 2%-70%, 5%-60%, 10%-50%, 15%-40%, 20%-30%, 25%-60%, 30%-60%, or35%-60% of active ingredient.

In an aspect, a therapeutic composition can be incorporated intotablets, drenches, boluses, capsules or premixes. Formulation of theseactive ingredients into such dosage forms can be accomplished by meansof methods well known in the pharmaceutical formulation arts. See, e.g.,U.S. Pat. No. 4,394,377. Filling gelatin capsules with any desired formof the active ingredients readily produces capsules. If desired, thesematerials can be diluted with an inert powdered diluent, such as sugar,starch, powdered milk, purified crystalline cellulose, or the like toincrease the volume for convenience of filling capsules.

In an aspect, conventional formulation processes can be used to preparetablets containing a therapeutic composition. In addition to the activeingredients, tablets may contain a base, a disintegrator, an absorbent,a binder, and a lubricant. Typical bases include lactose, sugar, sodiumchloride, starch and mannitol. Starch is also a good disintegrator as isalginic acid. Surface-active agents such as sodium lauryl sulfate anddioctyl sodium sulphosuccinate are also sometimes used. Commonly usedabsorbents include starch and lactose. Magnesium carbonate is alsouseful for oily substances. As a binder there can be used, for example,gelatin, gums, starch, dextrin, polyvinyl pyrrolidone and variouscellulose derivatives. Among the commonly used lubricants are magnesiumstearate, talc, paraffin wax, various metallic soaps, and polyethyleneglycol.

In an aspect, for preparing solid compositions such as tablets, anactive ingredient is mixed with a pharmaceutical carrier, e.g.,conventional tableting ingredients such as corn starch, lactose,sucrose, sorbitol, talc, stearic acid, magnesium stearate, dicalciumphosphate or gums, or other pharmaceutical diluents, e.g. water, to forma solid preformulation composition containing a homogeneous mixture of acomposition of the present invention. When referring to thesepreformulation compositions as homogeneous, it is meant that the activeingredient is dispersed evenly throughout the composition so that thecomposition may be readily subdivided into equally effective unit dosageforms such as tablets, pills and capsules. This solid preformulationcomposition is then subdivided into unit dosage forms of the typedescribed above containing a desired amount of an active ingredient(e.g., at least about 10⁵, 10⁶, 10⁷, 10⁸, 10⁹, 10¹⁰, 10¹¹, 10¹², or 10¹³cfu). A therapeutic composition used herein can be flavored.

In an aspect, a therapeutic composition can be a tablet or a pill. Inone aspect, a tablet or a pill can be coated or otherwise compounded toprovide a dosage form affording the advantage of prolonged action. Forexample, a tablet or pill can comprise an inner dosage and an outerdosage component, the latter being in the form of an envelope over theformer. The two components can be separated by an enteric layer whichserves to resist disintegration in the stomach and permits the innercomponent to pass intact into the duodenum or to be delayed in release.A variety of materials can be used for such enteric layers or coatings,such materials including a number of polymeric acids and mixtures ofpolymeric acids with such materials as shellac, cetyl alcohol andcellulose acetate.

In an aspect, a therapeutic composition can be a drench. In one aspect,a drench is prepared by choosing a saline-suspended form of atherapeutic composition. A water-soluble form of one ingredient can beused in conjunction with a water-insoluble form of the other bypreparing a suspension of one with an aqueous solution of the other.Water-insoluble forms of either active ingredient may be prepared as asuspension or in some physiologically acceptable solvent such aspolyethylene glycol. Suspensions of water-insoluble forms of eitheractive ingredient can be prepared in oils such as peanut, corn, sesameoil or the like; in a glycol such as propylene glycol or a polyethyleneglycol; or in water depending on the solubility of a particular activeingredient. Suitable physiologically acceptable adjuvants may benecessary in order to keep the active ingredients suspended. Adjuvantscan include and be chosen from among the thickeners, such ascarboxymethylcellulose, polyvinyl pyrrolidone, gelatin and thealginates. Surfactants generally will serve to suspend the activeingredients, particularly the fat-soluble propionate-enhancingcompounds. Most useful for making suspensions in liquid nonsolvents arealkylphenol polyethylene oxide adducts, naphthalenesulfonates,alkylbenzene-sulfonates, and the polyoxyethylene sorbitan esters. Inaddition many substances, which affect the hydrophilicity, density andsurface tension of the liquid, can assist in making suspensions inindividual cases. For example, silicone anti-foams, glycols, sorbitol,and sugars can be useful suspending agents.

In an aspect, a therapeutic composition comprises non-pathogenic sporesof one or more, two or more, three or more, or four or more Clostridiumspecies selected from the group consisting of Clostridium absonum,Clostridium argentinense, Clostridium baratii, Clostridium botulinum,Clostridium cadaveris, Clostridium carnis, Clostridium celatum,Clostridium chauvoei, Clostridium clostridioforme, Clostridiumcochlearium, Clostridium fallax, Clostridium felsineum, Clostridiumghonii, Clostridium glycolicum, Clostridium haemolyticum, Clostridiumhastiforme, Clostridium histolyticum, Clostridium indolis, Clostridiumirregulare, Clostridium limosum, Clostridium malenominatum, Clostridiumnovyi, Clostridium oroticum, Clostridium paraputrificum, Clostridiumperfringens, Clostridium piliforme, Clostridium putrefaciens,Clostridium putrificum, Clostridium sardiniense, Clostridiumsartagoforme, Clostridium scindens, Clostridium septicum, Clostridiumsordellii, Clostridium sphenoides, Clostridium spiroforme, Clostridiumsporogenes, Clostridium subtenninale, Clostridium symbiosum, Clostridiumtertium, Clostridium tetani, Clostridium welchii, and Clostridiumvillosum.

In an aspect, a therapeutic composition comprises purified, isolated, orcultured viable non-pathogenic Clostridium and a plurality of purified,isolated, or cultured viable non-pathogenic microorganisms from one ormore genera selected from the group consisting of Collinsella,Coprococcus, Dorea, Eubacterium, and Ruminococcus. In another aspect, atherapeutic composition comprises a plurality of purified, isolated, orcultured viable non-pathogenic microorganisms from one or more generaselected from the group consisting of Clostridium, Collinsella,Coprococcus, Dorea, Eubacterium, and Ruminococcus.

In an aspect, a therapeutic composition comprises two or more generaselected from the group consisting of Collinsella, Coprococcus, Dorea,Eubacterium, and Ruminococcus. In another aspect, a therapeuticcomposition comprises two or more genera selected from the groupconsisting of Coprococcus, Dorea, Eubacterium, and Ruminococcus. In afurther aspect, a therapeutic composition comprises one or more, two ormore, three or more, four or more, or five or more species selected fromthe group consisting of Coprococcus catus, Coprococcus comes, Dorealongicatena, Eubacterium eligens, Eubacterium hadrum, Eubacteriumhallii, Eubacterium rectale, and Ruminococcus torques.

In one aspect, a therapeutic composition comprises at least about 10⁵,10⁶, 10⁷, 10⁸, 10⁹, 10¹⁰, 10¹¹, 10¹², or 10¹³ cfu. In another aspect, atherapeutic composition comprises at most about 10⁵, 10⁶, 10⁷, 10⁸, 10⁹,10¹⁰, 10¹¹, 10¹², 10¹³ or 10¹⁴ cfu.

In another aspect, a therapeutic composition comprises at least about10⁵, 10⁶, 10⁷, 10⁸, 10⁹, 10¹⁰, 10¹¹, 10¹², or 10¹³ cells. In anotheraspect, a therapeutic composition comprises at most about 10⁵, 10⁶, 10⁷,10⁸, 10⁹, 10¹⁰, 10¹¹, 10¹², 10¹³ or 10¹⁴ cells.

From the foregoing, it will be appreciated that the present inventioncan be embodied in various ways, which include but not limited to thefollowing embodiments:

1. A method for treating ulcerative colitis (UC) in a subject in needthereof comprising treating the subject with a treatment regimencomprising the administration of a pharmaceutical composition comprisinglive non-pathogenic fecal bacteria for at least 8 weeks and at leastthree times per week.

2. A method for treating a condition in a subject in need thereofcomprising treating the subject with a treatment regimen comprising theadministration of a pharmaceutical composition comprising livenon-pathogenic fecal bacteria for at least 8 weeks and at least threetimes per week, where the condition is selected from the groupconsisting of collagenous colitis, lymphocytic colitis, Crohn's colitis,diverticulitis, and pouchitis.

3. The method of embodiment 1 or 2, where the treatment regimen iscapable of achieving a primary outcome rate of at least two fold higherrelative to a primary outcome rate from placebo, where the primaryoutcome is defined as a steroid-free clinical remission and endoscopicremission or response at the end of the treatment regimen, where theclinical remission is defined as a total Mayo score of 2 or lower withall sub-scores of 1 or lower, where the endoscopic remission or responseis defined as a reduction of at least 1 point from baseline in Mayoendoscopy score.

4. The method of embodiment 3, where the treatment regimen is capable ofachieving a primary outcome rate of at least 25%.

5. The method of embodiment 3, where the treatment regimen is capable ofachieving a primary outcome rate between 20% and 40%.

6. The method of embodiment 3, where the treatment regimen is capable ofachieving a clinical remission sustaining rate of at least 40% at 8weeks after the completion of the treatment regimen.

7. The method of embodiment 3, where the treatment regimen is capable ofachieving a clinical remission sustaining rate of between 35% and 60% at8 weeks after the completion of the treatment regimen.

8. The method of embodiment 1 or 2, where the treatment regimen iscapable of achieving a steroid-free clinical remission rate of at leasttwo fold higher relative to a steroid-free clinical remission rate fromplacebo, where the clinical remission is defined as a combined Mayoscore of 1 or lower for rectal bleeding and stool frequency.

9. The method of embodiment 8, where the treatment regimen is capable ofachieving a steroid-free clinical remission rate of at least 40%.

10. The method of embodiment 8, where the treatment regimen is capableof achieving a steroid-free clinical remission rate between 35% and 55%.

11. The method of embodiment 1 or 2, where the treatment regimen iscapable of achieving a steroid-free clinical response rate of at leasttwo fold higher relative to a steroid-free clinical response rate fromplacebo, where the clinical response is defined as a total Mayo scoredecrease of 3 or higher or a 50% or higher reduction from baseline incombined score for rectal bleeding and stool frequency.

12. The method of embodiment 11, where the treatment regimen is capableof achieving a steroid-free clinical response rate of at least 50%.

13. The method of embodiment 11, where the treatment regimen is capableof achieving a steroid-free clinical response rate between 45% and 65%.

14. The method of embodiment 1 or 2, where the treatment regimen iscapable of achieving an endoscopic response rate of at least two foldhigher relative to an endoscopic response rate from placebo, where theendoscopic response is defined as a total UCEIS score decrease of 3 orhigher or a 50% or higher reduction from baseline.

15. The method of embodiment 14, where the treatment regimen is capableof achieving an endoscopic response rate of at least 30%.

16. The method of embodiment 14, where the treatment regimen is capableof achieving an endoscopic response rate between 30% and 45%.

17. The method of embodiment 1 or 2, where the method further comprisesdetermining the subject's baseline gut bacterial diversity.

18. The method of embodiment 17, where the subject's baseline gutbacterial diversity is assessed by analyzing Shannon's diversity of thesubject's fecal sample prior to the treating step.

19. The method of embodiment 18, where the subject's fecal Shannon'sdiversity is between 0.5 and 2.2 based on bacterial species level.

20. The method of embodiment 1 or 2, where the method further comprisesdetermining the level of Fusobacterium, Sutterella, or both in thesubject's gut.

21. The method of embodiment 1 or 2, where the method further comprisesdetermining the level of one or more bacteria selected from the groupconsisting of Barnesiella, Parabacteroides, Clostridium IV,Ruminococcus, Blautia, Dorea, Ruminococcus2, and Clostridium XVIII inthe subject's gut.

22. The method of embodiment 1 or 2, where the pharmaceuticalcomposition comprises a fecal microbiota preparation.

23. The method of embodiment 1 or 2, where the subject exhibits a Mayoscore of at least 4 prior to the treating step.

24. The method of embodiment 1 or 2, where the subject exhibits a Mayoscore of 4 to 10 prior to the treating step.

25. A method for treating ulcerative colitis (UC) in a subject in needthereof and exhibiting a Mayo endoscopy score of 3 or lower, the methodcomprising administering to the subject a pharmaceutical compositioncomprising live non-pathogenic fecal bacteria.

26. The method of embodiment 25, where the administering is following atreatment regimen lasting for at least 8 weeks.

27. The method of embodiment 25, where the administering is following atreatment regimen of at least 8 weeks and at least three times per week.

28. The method of embodiment 27, where the subject is capable ofachieving a primary outcome at the end of the treatment regimen, wherethe primary outcome is defined as a steroid-free clinical remission andendoscopic remission or response at the end of the treatment regimen,where the steroid-free clinical remission is defined as a total Mayoscore of 2 or lower with all sub-scores of 1 or lower, where theendoscopic remission or response is defined as a reduction of at least 1point from baseline in endoscopy score.

29. The method of embodiment 25, where the administering step isfollowing a treatment regimen of daily for at least 8 weeks.

30. A method for treating ulcerative colitis (UC) in a subject in needthereof, the method comprising administering to the subject apharmaceutical composition comprising live non-pathogenic fecalbacteria, where the subject has no concomitant corticosteroid use duringsaid method and has no corticosteroid use immediately prior tocommencing the method.

31. The method of embodiment 30, where the subject has no steroid usewithin at least one week prior to commencing the method.

32. The method of embodiment 30, where the subject has no corticosteroiduse within at least one week prior to commencing the method.

33. The method of embodiment 30, where the subject has no corticosteroiduse prior to commencing the method.

34. The method of embodiment 30, where the administering is following aregimen lasting for at least 8 weeks.

35. The method of embodiment 30, where the administering is following aregimen of at least 8 weeks and at least three times per week.

36. The method of embodiment 35, where the subject is capable ofachieving a primary outcome at the end of the regimen, where the primaryoutcome is defined as a steroid-free clinical remission and endoscopicremission or response at the end of the treatment regimen, where thesteroid-free clinical remission is defined as a total Mayo score of 2 orlower with all sub-scores of 1 or lower, where the endoscopic remissionor response is defined as a reduction of at least 1 point from baselinein endoscopy score.

37. A method for selecting a treatment plan for treating ulcerativecolitis (UC) in a subject in need thereof, the method comprisingdetermining the level of Fusobacterium, Sutterella, or both in thesubject's gut; and recommending a fecal bacteria-based therapy when thelevel of Fusobacterium, Sutterella, or both is below a predeterminedlevel.

38. A method for selecting a treatment plan for treating ulcerativecolitis (UC) in a subject in need thereof, the method comprisingdetermining the level of one or more bacteria selected from the groupconsisting of Barnesiella, Parabacteroides, Clostridium IV,Ruminococcus, Blautia, Dorea, Ruminococcus2, and Clostridium XVIII inthe subject's gut; and recommending a fecal bacteria-based therapy whenthe level of one or more bacteria selected from the group consisting ofis above a predetermined level.

39. The method of embodiment 37 or 38, where the level of one or morebacteria is determined via analyzing said subject's feces.

EXAMPLES Example 1. Patient Selection Criteria

Patients, including males and females aged 18 to 75 years, who haveclinically and endoscopically active ulcerative colitis, with a totalMayo score of 4-10, which incorporates stool frequency, rectal bleeding,mucosal appearance at endoscopy, and physician's global assessment (PGA)are included. The endoscopy score has to be ≥1 and PGA score ≤2.Furthermore, such ulcerative colitis has to be present for more thanthree months in duration. Ulcerative colitis of any extent is treatedexcept for isolated proctitis that are <5 cm. See Table 4 for allinclusion criteria.

TABLE 4 Study Participant Inclusion Criteria Patients must meet all thefollowing INCLUSION CRITERIA at enrolment to be eligible toparticipate 1. Males and females aged 18 to 75 years, inclusive 2.Ulcerative colitis >3 months duration 3. Ulcerative Colitis of anyextent except isolated proctitis <5 cm 4. Currently active mild-moderateulcerative colitis, as measured by a Mayo score of 4-10, whichincorporates stool frequency, rectal bleeding, mucosal appearance, andphysician's assessment as a four point category score. Endoscopy scoremust be 

1 and physician global assessment score 

2 5. Provide written informed consent to participate as shown by asignature on the consent form

Patients receiving treatment with oral 5-aminosalicylates, thiopurinesand methotrexate has to be at stable doses. Oral prednisolone is allowedin patients. Patients having undergone a mandatory oral prednisolone maytaper of up to 2.5 mg per week, and need to be steroid-free by week 8.

Patients receiving rectal therapies in the past 2 weeks, receivingantibiotics or probiotics in the past 4 weeks, and receiving biologictherapy in the past 12 weeks are to be excluded. Patients exhibitingevidence or history of toxic megacolon, as well as any other significantgastrointestinal conditions, including but not limited to irritablebowel syndrome, diverticulitis, and neoplasm, are also excluded.Patients being diagnosed of Crohn's disease or indeterminate colitis areexcluded. Patients with perianal disease such as fistulae andpre-existing fissures are excluded. Patients with severe anaemia,leucopaenia, or granulocytopenia are excluded. Patients who hadappendectomy less than 3 months prior to treatment are also excluded.Patients with significant food hypersensitivity are excluded. See Table5 for all exclusion criteria.

TABLE 5 Study Participant Exclusion Criteria Patients must not meet anyof the following EXCLUSION CRITERIA at enrolment to be eligible toparticipate  1. Consent not obtained or unable to give informed consent 2. Unable to communicate with the investigators and comply with thestudy requirements  3. Females who are pregnant or actively trying tofall pregnant  4. Patients unwilling to practice an effective method ofcontraception throughout the study period  5. Patients defined as inremission by the investigator  6. Patients with mild ulcerative colitis(Mayo score <4)  7. Patients with severe ulcerative colitis (Mayoscore >10)  8. Evidence or history of toxic megacolon  9. Isolatedproctitis <5 cm 10. A diagnosis of Crohn's Disease or indeterminatecolitis 11. Patients with perianal disease (e.g. fistulae, pre-existingfissures) 12. Severe anaemia, leucopaenia or granulocytopenia 13.Detection of a gastrointestinal pathogen on stool analysis Need toexclude/treat active GI infection before inclusion into study (e.g.giardia, C. diff, CMV etc.) Prior GI infection is not an exclusion toenrolment as long as successful treatment and eradication is documented14. Constipation-predominant Ulcerative Colitis with <3 bowelmotions/day 15. Any other significant GI condition e.g. Irritable bowelsyndrome, diverticulitis, neoplasm etc. 16. Significant gastrointestinalsurgery e.g. colon resection, colectomy Minor gastrointestinal surgerywill be reviewed on a case by case basis by the investigator Regardingappendicectomy, only exclude patients who had appendicectomy <3 monthsago 17. Patients taking antimicrobials (antibiotics, antifungals,antivirals) for any reason, including antibiotics for ulcerativecolitis, in the preceding four weeks 18. Patients who are steroiddependent and requiring >20 mg prednisone or >9 mg budesonide daily atthe time of enrolment 19. Patients who have recently taken or areactively taking or expected to require prohibited medication/s duringthe study period including follow-up. These include Treatment withanti-tumour necrosis factor agents e.g. infliximab, adalimumab, withinthe last 12 weeks Treatment with other major immunosuppressant agentsincluding calcineurin inhibitors, mammalian target of rapamycin (mTOR)inhibitors, chemotherapeutic anti-neoplastic agents, lymphocytedepleting biological agents within the last 12 weeks Probiotic therapyin the last 4 weeks Experimental/trial drug protocol involvement in last12 weeks Anti-mycobacterial (TB or MAC) therapy in last 4 weeks 20.Clinical evidence of any major, co-morbid chronic disease that mayinterfere with the patient's ability to enter the trial. Patients with aconcomitant illness sufficiently severe as to jeopardize participationin the study or interpretation of results will be excluded from thestudy In particular, severe immunodeficiency including but not limitedto decompensated liver cirrhosis, advanced HIV/AIDS and recent bonemarrow transplant will be an absolute contraindication to FMT 21.Patients with food hypersensitivity deemed by the investigator to besignificant during the trial e.g., nut allergy 22. Patients who havetravelled overseas to an infectious diarrhea endemic area within thelast month or have overseas travel planned during the study period (notfeasible to be compliant with enema therapy)

Based on the above criteria, eighty-five patients are recruited in thisstudy. The selected patients are randomized with 81 commencing treatment(FIG. 1). The two groups are well matched except for disease severity;significantly more patients with the mildest (Mayo 1) endoscopic diseaseare randomized to placebo. Table 6 summarizes the baselinecharacteristics of the recruited patients.

TABLE 6 Baseline Patient Characteristics. FJIT Placebo P (n = 41.) (n =−40) Value Age, y 35.5 (27.8-48.9) 35.4 (27.7-45.6) 0.97 Male Sex, n (%)22 (54%) 25 (63%) 0.42 Caucasian race, n (%) 27 (66%) 27 (68%) 0.88 NonSmoker, n (%) 23 (56%) 21 (53%) 0.75 UC < 1 year, n (%) 2 (5%) 2 (5%)0.98 Disease Duration, y 5.8 (3.4-9.0) 5.8 (2.7-9.4) 0.55 DiseaseExtent, n (%) Proctitis 4 (10%) 8 (20%) 0.19 Left Sided Colitis 28 (68%)20 (50%) 0.09 Pancolitis 9 (22%) 12 (30%) 0.41 Concomitant Medications,n (%) Nil 9 (22%) 6 (15%) 0.42 Oral 5-ASA 26 (63%) 28 (70%) 0.53 OralImmunomodulator 20 (49%) 15 (38%) 0.31 Oral Steroids 9 (22%) 11 (28%)0.56 Prior Anti-TNIF Therapy, 9 (22%) 6 (15%) 0.42 n (1%) Prior OtherBiologic Therapy, 2 (5%) 0 (0%) 0.16 n (%) Mayo Score 8 (6-9) 8 (6-9)0.43 Mayo Endoscopic Subscore, n (%) Mayo 1 1 (2%) 7 (18%) 0.02* Mayo 227 (65%) 15 (38%) 0.01* Mayo 3 13 (32%) 18 (45%) 0.22 UCEIS Score 4(3.5-5.5) 4 (3-5) 0.76 IBDQ Score 123 (99-157) 119 (109-149) 0.78 FaecalCalprotectin, ug/g 705 (226-1220) 505 (193-1475) 0.41 ErythrocyteSedimentation 14 (5.5-29.5) 10 (5-20) 0.20 Rate, mm/hr C -ReactiveProtein, mg/L 2.6 (1.0-7.1) 2.9 (0.8-5.8) 0.93 White Cell Count. ×10⁹/L7.8 (6.2-9.7) 8.0 (6.3-9.9) 0.71 Neutrophil Count, ×10⁹/L 4.8 (3.5-6.9)5.7 (3.7-6.7) 0.60 Haemoglobin, g/L 134 (129-143) 136 (127-148) 0.56Platelet Count, ×10⁹/L 299 (248-352) 306 (251-362) 0.48 Albumin, g/L 46(43-48) 45 (43-48) 0.50

Example 2. Stool Donors Selection

Stool donors, including males and females aged 18 to 65 years, who haveno history or current symptoms of gastrointestinal disease including butnot limited to inflammatory bowel disease and irritable bowel syndromeare included. Donors should not have any major active medicalco-mobidities. Donors should have minimal regular medications with nomedications that may interfere with stool viability, including noantimicrobials, probiotics and proton pump inhibitors in the precedingthree months prior to donation. See Table 7 for all donor inclusioncriteria.

TABLE 7 Healthy Fecal Donor Inclusion Criteria Donors must meet all thefollowing INCLUSION CRITERIA at enrolment 1. Males and females aged 18to 65 years, inclusive 2. No history or current symptoms ofgastrointestinal disease including but not limited to inflammatory boweldisease (IBD) and irritable bowel syndrome (IBS) 3. No other majoractive medical co-morbidities 4. Minimal regular medications with nomedications that may interfere with stool viability including noantimicrobials (antibiotics, antivirals,antifungals), probiotics andproton pump inhibitors (PPIs) in the preceding 3 months 5. Providewritten informed consent to participate as shown by a signature on theconsent form

To exclude unhealthy donors, a potential donor's stool is evaluatedusing one or more of the following tests: Clostridium difficile toxinPCR, fecal microscopy/culture/sensitivity with routine bacterial culturefor enteric pathogens, fecal Giardia antigen, fecal Cyrptosporidiumantigen, fecal ova/cysts/parasites (including Blastocystis hominis andDientamoeba fragilis), and Norovirus EIA. A potential donor's blood isalso tested for one or more of the following: complete blood count(CBC); electrolytes, urea and creatinine (EUC); liver function tests(LFT); erythrocyte sedimentation rate (ESR); C-Reactive protein (CRP);human immunodeficiency virus (HIV) type 1 and 2; Hepatitis A virus IgM;Hepatitis B virus surface antigen, Hepatitis B virus core antibody(IgM+IgG), Hepatitis B virus surface antibody; Hepatitis C virusantibody; Rapid plasma regain and/or fluorescent treponemalantibody-absorbed; and human T-cell lymphotropic virus (HTLV) 1 and 2.

TABLE 8 Healthy Fecal Donor Exclusion Criteria Donors must not meet anyof the following EXCLUSION CRITERIA at enrolment 1. Risk of infectiousagent Known HIV, hepatitis B or hepatitis C infection Known exposure toHIV or viral hepatitis within the previous 12 months High risk sexualbehavior (e.g. sexual contact with anyone with HIV/AIDS or viralhepatitis, men who have sex with men, sex for drugs or money) Use ofillicit drugs Tattoo or body piercing within the preceding 6 monthsIncarceration or history of incarceration Known current communicabledisease (e.g. upper respiratory tract infection) Risk factors forvariant Creutzfeldt-Jakob disease Travel within last 2 weeks to areas ofthe world where diarrheal illnesses are endemic or risk of traveler'sdiarrhea is high 2. Gastrointestinal co-morbidities History of orcurrent inflammatory bowel disease (IBD) History of or current irritablebowel syndrome (IBS), chronic constipation, chronic diarrhea or otherintrinsic gastrointestinal illness/condition History of or currentgastrointestinal malignancy or known polyposis or strong family historyof colorectal cancer History of major gastrointestinal surgery (e.g.gastric bypass, partial colectomy) 3. Factors that can affect thecomposition of the intestinal microbiota Antimicrobials (antibiotics,antivirals, antifungals), probiotics or proton pump inhibitors (PPIs)within the preceding 3 months Major immunosuppressive medications (e.g.calcineurin inhibitors, biological agents, exogenous glucocorticoids)Systemic anti-neoplastic agents Household members with active GIinfection 4. Other conditions Systemic autoimmunity (e.g. multiplesclerosis, connective tissue disease) Atopic disease (e.g. moderate -severe asthma, eosinophilic disorders of the gastrointestinal tract)Metabolic syndrome, obesity (BMI > 30) or moderate to severeunder-nutrition/malnutrition Chronic pain syndromes (e.g. chronicfatigue syndrome, fibromyalgia) or neurologic/ neurodevelopmentaldisorders History of malignant illness or ongoing oncologic therapy

Based on the above criteria and tests, 14 donors are selected.

Example 3. FMT and Placebo Preparation and Storage

FMT infusions are constituted from the blended stool of 3 to 7 donors,to increase microbial heterogeneity. Each patient receives all their FMTinfusions from the same donor batch to ensure consistency andreproducibility of the infused fecal microbiota.

Placebo infusions comprise isotonic saline. Odorant, brown food colourdisodium4,4′-2,4-dihydroxy-5-hydroxymethyl-1,3-phenylene-bisazodi-1-napthalenesulfonate (to replicate fecal odour and colour respectively), andglycerol cryoprotectant (concentration 10%) are added to the 150 mlplacebo and FMT infusions, which are then stored at −80° C.

Three to seven of the selected donors contributes to each of the 21 FMTbatches in the study. The use of multiple donors for all infusions isone of the features of this study.

Example 4. Study Design

At three clinical centers patients are randomized 1:1 double-blind toFMT:placebo using permutated blocks of 4, stratified for study site andconcomitant corticosteroid use.

After full bowel preparation, colonoscopy is performed to the terminalileum and the initial infusion administered. Patients thenself-administer enemas 5 times per week for 8 weeks. After 8 weeksmucosal inflammation is assessed with sigmoidoscopy.

After the initial 8 week study period placebo-treated patients areoffered 8 weeks of open-label FMT enemas 5 times per week, withoutinitial colonoscopic infusion. Sigmoidoscopy is repeated afteropen-label FMT.

FIG. 2 shows a graphical representation of this study design.

Example 5. Study Assessments and Endpoints

Patients are reviewed fortnightly during blinded and open label studyperiods with a final review 8 weeks post FMT. Blood and stoolinvestigations are performed every 4 weeks during study therapy. Bloodtests include CBC, EUC, LFT, ESR, and CRP. Stool tests include fecalcalprotectin.

Evaluation of the site of worst inflammation at each endoscopy, usingthe Mayo endoscopy sub-score and UCEIS score, is undertaken with blindedreview and central consensus scoring of all endoscopic photo images by 5IBD-expert gastroenterologists.

The primary composite outcome is steroid-free clinical remissiontogether with endoscopic remission or response at week 8, defined as atotal Mayo score of

2 with all sub-scores

1 and

1 point reduction from baseline in endoscopy score.

Eleven of 41 (27%) FMT-treated patients and 3 of 40 (8%) placebo-treatedpatients achieve the primary outcome (P=0.02, OR 4.5 (95% CI 1.2-17.7))(FIG. 3A, FIG. 4A-D).

FIG. 3A shows the number of patients in the FMT and placebo-treatedgroups who achieved the primary outcome of steroid-free clinicalremission and endoscopic remission or response (total Mayo score

2 with all sub-scores

1 and

1 point reduction from baseline in endoscopy sub-score) at week 8. Thetotal Mayo score can range from 0 to 12, and sub-scores range from 0 to3, with higher scores indicating more severe disease.

FIG. 4A and FIG. 4B show the effect of a FMT therapy in a 37 year oldfemale patient with a 4 year history of left sided ulcerative colitisand acute colitis (diarrhea 6 times per day with bleeding) despitemaximal oral and topical 5-ASA therapy. FIG. 4A shows an exemplarybaseline endoscopic appearance of 25 cm recto-sigmoid active colitiswith endoscopic Mayo sub-score 2, and total Mayo score 8. FIG. 4B showsan exemplary endoscopic appearance in the same patient at the end ofweek 8 blinded FMT therapy with endoscopic Mayo sub-score 0, and totalMayo score 0. This patient remains in clinical remission at final studyfollow up 8 weeks after completing blinded FMT therapy.

FIG. 4C and FIG. 4D show the effect of a FMT therapy in a 28 year-oldfemale patient with a 7 year history of extensive ulcerative colitis.This patient experiences failed therapy with mesalamine, probiotic andadalimumab. Accordingly, the patient is maintained on azathioprine andallopurinol, and was steroid-dependent on oral budesonide 9 mg/day. Atstudy entry this patient has diarrhea 8 times per day with bleeding andabdominal pain. FIG. 4C shows an exemplary baseline endoscopicappearance of extensive colitis to the hepatic flexure with endoscopicMayo sub-score 3, and total Mayo score 10. This patient receives placebotreatment during the primary study, but was unable to tapercorticosteroids, and was therefore a treatment failure in the primaryoutcome. FIG. 4D shows Endoscopic appearance in the same patient at thecompletion of 8 weeks open-label FMT, with endoscopic Mayo sub-score 0and Total Mayo Score 0. After 8 weeks of open-label FMT this patient hasweaned corticosteroids completely and is in clinical and endoscopicremission.

Secondary outcomes include steroid-free clinical remission (combinedscore ≤1 for rectal bleeding plus stool frequency Mayo sub-scores),clinical response (decrease

3 and/or

50% reduction from baseline in combined rectal bleeding plus stoolfrequency Mayo sub-scores), endoscopic response (Mayo endoscopysub-score ≤1 with a reduction ≥1 from baseline), complete mucosalhealing (Mayo endoscopy sub-score 0), quality of life using IBDQ¹⁰ andsafety.

Blinded central reading of all endoscopic images is performed using bothMayo and UCEIS scoring. Assessing steroid free endoscopic outcomes usinga decrease

3 points and/or

50% reduction from baseline in UCEIS score, the difference between theFMT and placebo arms at week 8 was 37% vs. 10%, p<0.01, OR 5.2, 95% CI1.5-17.5. When the criteria of UCEIS

1 is used, the difference between FMT and placebo treated patients was17% vs. 8%, p=0.19, OR 2.5, 95% CI 0.6-10.6) at week 8.

Significant differences are observed in the total Mayo score, and in thedecrease in total Mayo score, at week 8, between the FMT and placebotreated groups (Table 9). IBDQ FMT data is available only from 31patients. All missing data is assigned worst value in the entire cohort.All continuous variables are reported as median and interquartile range.

TABLE 9 Week 8 Efficacy Outcomes. FMT Placebo Adjusted Outcome (n = 41,(n = 40, P Measure data on 32) data on 29) Value Total Mayo Score at 4(2-6) 7 (4-9) 0.01 8 weeks Total Mayo Score 4 (2.3-6.0) 1 (−0.5-2)<0.01  decrease at 8 weeks IBDO at 8 weeks 182 (135-206) 151 (130-195)0.21 (NS) IBDCI Improvement 40 (15-70) 23 (10-33) 0.13 (NS) at 8 weeksIBDC/increase of 18 (44%) 9 (23%) 0.04 32 points at 8 weeks CRP 2.8(1.0-1.3) 3.0 (1.7-4.9) 0.65 (NS) ESR 17 (6.5-21) 11 (6-20) 0.85 (NS)Calprotectin 335 (91-1150) 410 (157-1345) 0.55 (NS)

FIG. 3B shows the number of patients in steroid-free clinical remission(combined score of ≤1 for rectal bleeding plus stool frequency Mayosubscores) and clinical response (decrease ≥3 points and/or ≥50%reduction from baseline in the combined score for rectal bleeding plusstool frequency Mayo subscores) at week 8. Steroid-free clinicalremission (44% vs. 20%, P=0.02, OR 3.1, 95% CI 1.2-8.4) and steroid-freeclinical response (54% vs. 23%, P<0.01, OR 4.0, 95% CI 1.5-10.4) at week8 is significantly greater in FMT than placebo-treated patients.

FIG. 3C shows the number of patients with steroid-free endoscopicresponse (Mayo endoscopy sub-score ≤1 with a reduction ≥1 from baseline)and complete mucosal healing (Mayo endoscopy sub-score 0). At week 8steroid-free endoscopic response (32% vs 10%, P=0.02, OR 4.2, 95% CI1.2-14.2) is significantly greater in the FMT-treated patients. Completemucosal healing (Mayo 0: 12% vs. 8%, P=0.48, OR 1.7 95% CI 0.4-7.7) isgreater in the FMT than placebo arms but this difference was notsignificant. Outcomes are similar with UCEIS scoring (FIG. 5). FIG. 5shows the speed of onset of therapy. At the end of week 4 clinicalresponse is significantly greater in FMT [17 of 41 (41%)] than placebo[5 of 40 (13%)] treated patients (p<0.01, OR 5.0, 95% CI 1.6-15.3].Clinical remission do not differ significantly between treatment arms[12 of 41 (29%) vs 5 of 40 (13%) respectively (P=0.06, OR 2.9, 95% CI0.91-9.2)].

IBDQ score and inflammatory markers do not differ significantly betweengroups (Table 9).

Thirty seven initially placebo-treated patients proceed to open-labelFMT. After open-label FMT, 10 (27%) meet the primary endpoint, 17 (46%)are in clinical remission and 8 (22%) have complete mucosal healing.

No relationship between outcome and anatomical disease extent isobserved (P=0.23). The severity of endoscopic inflammation is associatedwith therapeutic outcomes (p=0.01) with no patient with Mayo endoscopyscore 3 at study entry achieving the primary outcome. Corticosteroid useis also associated with therapeutic outcome (p=0.02) with no patiententering the study on corticosteroids achieving the primary endpoint atthe end of blinded therapy; one patient on corticosteroids at open-labelFMT entry meets the primary endpoint at completion.

Sixty-three patients attend a final study follow-up 8 weeks aftercompleting double-blind or open-label FMT, of whom 28 are in clinicalremission and 20 require UC therapy escalation.

Nine patients on blinded FMT and 11 on placebo (P=0.56) withdraw or haveprotocol failure prior to week 8. The reasons for withdrawal or protocolfailure on blinded therapy include disease worsening on steroid wean (3FMT, 6 placebo), disease persistence or worsening in the absence ofsteroid wean (5 FMT, 3 placebo) and non-compliance (1 FMT, 2 placebo).

Eleven patients who commence open label FMT either withdraw or have aprotocol failure: 5 have disease worsening on steroid wean, 2 havedisease persistence or worsening in the absence of steroid wean, 4 arenon-compliant.

Thirty two (78%) FMT and 33 (83%) placebo-treated patients experience atleast one adverse event during blinded therapy, with no significantdifference in number or type of adverse events (Table 10). The mostcommon adverse events are self-limiting gastrointestinal complaints(abdominal pain, bloating, and flatulence). Six serious adverse events(SAEs) occur during study therapy: 2 blinded FMT, 1 placebo, 3 openlabel FMT. One patient with refractory colitis on blinded FMT withdrawat week 2 due to clinical and endoscopic (Mayo 2 to 3, UCEIS 5 to 7)deterioration, and underwent colectomy. One patient with moderate tosevere colitis remain unwell at week 3 of blinded active therapy,withdraw and is hospitalized for intravenous corticosteroid therapy. Onepatient with moderate to severe colitis is withdrawn at week 3 ofplacebo therapy and require hospitalization. Three initialplacebo-treated patients fail to improve with open-label FMT and werehospitalized for escalation of therapy.

TABLE 10 Adverse Events. FMT Placebo Open Label Follow Up Adverse Event(n = 41) (n = 40) P Value (n = 37) (n = 63) Total AE 78 80 0.78 (NS) 3514 Total Patients with AE 32 (78%) 33 (83%) 0.62 (NS) 18 (49%) 9 (14%)Total infection Related AE 11 17 0.22 (NS)  9  3 Total Patients withInfection 10 (24%) 14 (35%) 0.30 (NS) 8 (22%) 3 (5%) Related AEAbdominal pain 12 (29%) 11 (28%) 0.86 (NS) 5 (14%) 1 (2%) Colitis 10(24%) 9 (23%) 0.84 (NS) 3 (8%) 4 (6%) Flatulence 10 (24%) 8 (20%) 0.64(NS) 2 (5%) Bloating 8 (20%) 11 (28%) 0.40 (NS) 3 (8%) Upper RespiratoryTract 7 (17%) 6 (15%) 0.80 (NS) 4 (11%) 2 (3%) Infection Headache 4(10%) 2 (5%) 0.41 (NS) 2 (5%) Dizziness 3 (7%) 3 (8%) 0.97 (NS) — Fever3 (7%) 2 (5%) 0.67 (NS) — Rash 3 (7%) — — Nausea 2 (5%) 5 (13%) 0.22(NS) 1 (3%) ALT elevated 2 (5%) 2 (5%) 0.98 (NS) — 1 (2%) Chills 2 (5%)2 (5%) 0.98 (NS) — 1 (2%) Vomiting 2 (5%) 1 (3%) 0.57 (NS) — Back pain 2(5%) — — Flu like symptoms 1 (2%) 4 (10%) 0.16 (NS) 3 (8%) Enterocoritis1 (2%) 3 (8%) 0.29 (NS) — Diarrhoea 1 (2%) — 1 (3%) Fracture (foot) 1(2%) — — Reflux symptoms 1 (2%) — — Sinusitis 1 (2%) — — Haemorrhoids 1(2%) — — Elective Surgical procedure 1 (2%) — — Anxiety — 1 (3%) 1 (3%)1 (2%) Lung infection — 1 (3%) 1 (3%) Anal Fissure — 1 (3%) — FaecalIncontinence — 1 (3%) — Fatigue — 1 (3%) — Genital herpes — 1 (3%) —Irritability — 1 (3%) — Lip Infection — 1 (3%) — Otitis media — 1 (3%) —Sore throat — 1 (3%) — Urticarial — 1 (3%) — Arthralgia — — 1 (3%) ASTelevated — — 1 (3%) Blurred vision — — 1 (3%) Depression — — 1 (3%) Dryskin — — 1 (3%) Insomnia — — 1 (3%) Myalgia — — 1 (3%) Palpitations — —1 (3%) Productive cough — — 1 (3%) Anaemia — — — 1 (2%) Non ElectiveSurgical — — — 1 (2%) Procedure (intraoperative Soft tissue infection(Axillary — — — 1 (2%) abscess) Tremor — — — 1 (2%) Total SAE 2 (5%) 1(3%) 0.57 (NS) 3 (8%) 1 (2%)

Six serious adverse events are observed during study therapy: 2 blindedFMT, 1 placebo, 3 open-label FMT. One patient with refractory UC onblinded FMT is withdrawn due to clinical and endoscopic deterioration,and underwent colectomy. Three initial placebo-treated patients fail toimprove with open-label FMT and require hospitalization for intravenouscorticosteroids or anti-TNF therapy.

Multi-donor, intensive-dosing FMT in UC appear to be safe in the shortterm. Most serious adverse events relate to eithercorticosteroid-dependent or refractory patients unable to toleratesteroid wean, or patients with moderate to severe colitis. The patientwho undergone a colectomy while on FMT demonstrates that a small subsetof UC patients may be susceptible to disease worsening with thistherapy.

No individual donor or donor batch is significantly associated with theprimary outcome, although this particular study is not powered toevaluate this. One of the donor tends to be associated with benefit, 37%of patients with and 18% without this donor achieving the primaryoutcome (P=0.054). Donor batch does not correlate with the primaryendpoint or serious adverse events.

Based on available data and anecdotal experience, the predicted FMTremission rate is 60%, placebo rate is 15%, and dropout rate is 30%.Forty patients per group are required for an 80% probability ofdemonstrating a difference with a two-sided alpha of 0.05 onintention-to-treat analysis.

All analyses are intention to treat (ITT), including all patients whoreceived at least one study dose. Patients who require increasedtherapy, breach study protocol, fail to cease corticosteroids by week 8,or terminate the study for any reason are deemed treatment failures.Missing and incomplete data are assigned the worst value in the cohortfor statistical analyses.

Descriptive statistics are computed for all variables. Normallydistributed continuous data are expressed as mean and standarddeviation, and are analyzed using unpaired t-test. Data not normallydistributed are expressed as median and interquartile range and areanalyzed using Wilcoxon rank sum test. Categorical data are assessed byChi-square and Fisher's exact tests. Results are expressed as oddsratios with 95% confidence intervals. A p-value of <0.05 is consideredsignificant.

Statistical analyses are performed using SPSS version 23.0 software(Chicago, Ill.).

Example 6. Gastrointestinal Microbiota Analyses

Microbiological analyses are performed on patient, individual donor andFMT batch fecal samples. Samples are stored at −80° C. Fecal bacterialDNA is extracted. The 16S rRNA gene fragment is amplified using the F27and 519R primers, then is subjected to high throughput sequencing on anIllumina MiSeq platform (2×300 bp chemistry) to determine microbiotadiversity and abundance. Raw sequences are analyzed using MOTHUR(Schloss et al. Appl. Environ. Microbiol. 2009; 75:7537-41). Statisticaltests are performed on counts and relative abundances.

Diversity (α- and phylogenetic) analyses and statistical analysesincluding principal component analysis (PCA), CLUSTER with SIMPROFtesting, permutational MANOVA (PERMANOVA), and PERMDISP are performed onthe reads using MOTHUR and Primer-E (Clarke. J. of Ecology 1993;18(1):117-43). Linear Discriminant Analysis Effect Size (LEfSe) analysis(Segata et al. Genome Biol. 2011; 12:R60) is performed using the Galaxyweb application (Goecks et al. Genome Biol. 2010; 11:R86).

Fecal samples are collected from 70 patients. Three hundred and fourteenpatient and 113 donor fecal samples (55 individual donor and 58 batchsamples) are analyzed. The number of clean sequences obtained per sampleis 26976±540 Rarefaction curves suggest that sampling has reachedsaturation.

The number of operational taxonomic units (OTUs) and phylogeneticdiversity are significantly higher in donor batches than individualdonors (FIG. 6A and FIG. 6B). The number of OTUs and phylogeneticdiversity of donor samples (batch and individual) are significantlyhigher than baseline patient samples (FIG. 6A and FIG. 6B). *** in FIG.6A and FIG. 6B denotes P<0.0001.

OTU number and phylogenetic diversity increase significantly relative tobaseline in all FMT-treated patients at 4 and 8 weeks (p<0.0001) andpersist 8 weeks post-FMT (p<0.0001) (FIG. 6A and FIG. 6B). Similarpatterns are observed for species richness and Shannon's diversity.

Significant differences in microbial profiles and reduced dispersionlevels are observed from OTU to Class taxonomic levels following FMT.PCA confirms the changes in microbial profiles of patients undergoingFMT (FIG. 6C). Patient profiles shift from a dominance of Bacteroides toPrevotella (FIG. 6C). The shift in microbial profiles of patientsundergoing FMT towards the donor is most notable at the OTU level.

Patient baseline samples are compared with week 4, week 8, and 8 weekspost-FMT to identify taxa altered by FMT, and with donor samples toidentify OTUs associated with donor batches and those associated withthe patient. Two hundred and ninety-five microbial taxa across alltaxonomic levels are transplanted with FMT, of which 78 show strongassociations (LDA score >3). There is a decrease in patient Bacteroides(e.g. OTU 8, 15, 69) and a marked increase in donor Prevotella (e.g. OTU2) and donor Bacteroides (e.g. OTU 12, 26, 56) with FMT, independent ofclinical outcome. This pattern is more apparent when OTUs are picked athigher resolution.

Blinded FMT-treated patients who achieve the primary outcome tend tohave higher baseline alpha-diversity than those who do not (P=0.1, FIG.6D). Blinded FMT-treatment is associated with significantly increaseddiversity in all patients; however patients who achieve the primaryoutcome have greater diversity during FMT and 8 weeks post-FMT,achieving levels higher than individual donors though lower than thedonor batches (FIG. 6D). Increased α-diversity is specific to FMT; threepatients who meet the primary outcome on placebo show no change indiversity.

To identify microbial taxa associated with primary outcome on FMT, LEfSeanalyses are performed with blinded FMT and open-label FMT patients arestratified. 87 taxa are significantly associated with primary outcome inblinded patients and 46 taxa in open label FMT patients. A range ofmicrobial taxa are associated with remission in the blinded FMT (e.g.Barnesiella, Parabacteroides, Clostridium IV and Ruminococcus) and openlabel FMT patients (e.g. Blautia, Dorea, Ruminococcus2, and ClostridiumXVIII). Both Fusobacterium and Sutterella are consistently associatedwith lack of remission in both blinded and open label FMT patients; forFusobacterium this involves either lack of eradication in patients whodo not achieve remission, transplantation into patients withoutremission, or eradication in patients who achieve remission.

Example 7. Treatment-Naïve Ulcerative Colitis Patient Treated with OralFecal Microbiome Therapy

A 44-year old treatment-naïve male patient (patient DM) presents with aone year history of diarrhea, blood and mucous in stool,cramping/abdominal pain, and weight loss. The patient experiences severepain upon defecation, incontinence whilst driving, loss of appetite,nausea, inability to eat spicy foods and fish, brain fog, and weightloss of 16 lbs. The patient also experiences 10-12 bowel movements perday with a consistency of 7 (Bristol), severe bloating, severe abdominaldiscomfort, and severe urgency. The patient is diagnosed with severepancolitis. A treatment regimen including acid resistant/delayed releasedouble encapsulated oral capsules containing lyophilized donor-derivednon-selected fecal microbiota is used. Briefly, donor stool is collectedand homogenized with cryoprotectant and the resulting slurry islyophilized and encapsulated in DRcaps® capsules containing ˜1.6×10¹¹viable cells/capsule. The patient is treated with a total of 404capsules over a 13-week induction period. During this period, symptomquestionnaires are collected and stools are cultured for pathogens toassess efficacy of the LFSM treatment.

The patient's UC symptoms show improvement (see Table 11). By week 8post-treatment, blood and mucous are barely visible in stool, by week 10it is nil. The patient's incontinence ceases and bowel motions decreaseto 2-3/day with a consistency of 4 (Bristol). With continuing treatment,calprotectin levels decrease from 600 μg/g in week 22, to 344 μg/g inweek 26. This confirms an ongoing inflammation reduction which is alsoshown by endoscopy in FIG. 7. The patient does not report anyside-effects relating to the tolerability of the treatment. This caserepresents a successful treatment of ulcerative colitis (UC) with oralfecal microbiome therapy. In addition to the quality of life (QoL)improvement which result from the patient's UC symptom improvements,there is also a significant increase in energy levels that allows fordaily exercise and confidence to recommence work due to reducedincontinence. The patient continues well on maintenance treatment of 4capsules per day. Oral fecal microbiome therapy is efficacious whentreating a treatment-naïve UC patient with pancolitis, resulting in anoverall improved QoL.

TABLE 11 Symptoms Pre- and Post- Treatment Pre-Treatment Post-TreatmentSymptoms Symptoms Daily BM & Bristol Stool Cart 6-10, BSC - 5/6/7 2 BM,BSC - 4/5 Type Abdominal Pain/Discomfort 3-4 1 Urgency to pass a motion4 1 Difficulty passing a motion 2 1 Pain during defecation 3-4 1Bloating 1 1 Constipation 1 1 Diarrheoea 4 1 Blood in stool 3 1 Mucus instool 4 2 Flatulence 1 1 Nausea 3 1 Fatigue 2 1 General Malaise 3 2 1 -none; 2 - Mild; 3 - Moderate; 4 - Severe

Example 8. Ulcerative Colitis Patient Treated with Oral Fecal MicrobiomeTherapy

A 31-year old patient (patient TD) is treated with fecal microbiometherapy. A treatment regimen including acid resistant/delayed releasedouble encapsulated oral capsules containing lyophilized donor-derivednon-selected fecal microbiota is used. The patient's symptoms include of4 bowel movements per day with a consistency of 2, moderate bloating,moderate abdominal discomfort, mild urgency, and feelings of pins andneedles in legs and fatigue. The patient is placed on a 6 week treatmentprotocol with one fecal microbiome therapy liquid colonoscopic infusionand 1-2 rectal enema infusions per week during the induction period. Thepatient takes 4 capsules per day for 4 weeks during the maintenanceperiod. The patients symptoms of bloating decrease and symptoms ofabdominal discomfort and urgency disappear. The patient experiences onebowel movement per day with a consistency of 3. The patient alsoexperiences mild flatulence and general malaise. Two weeks after capsuletreatment the patient has a calprotectin reading of 243 μg/g. Threeweeks from the first calprotectin test and 4 weeks from the initialcapsule intake, the patient's calprotectin level decreases to 88 μg/g.

As various modifications could be made in the constructions and methodsherein described and illustrated without departing from the scope of thedisclosure, it is intended that all matter contained in the foregoingdescription shall be interpreted as illustrative rather than limiting.The breadth and scope of the present disclosure should not be limited byany of the above-described exemplary embodiments, but should be definedonly in accordance with the following claims appended hereto and theirequivalents. All patent and non-patent documents cited in thisspecification are incorporated herein by reference in their entirety.

The invention claimed is:
 1. A method for treating ulcerative colitis(UC) in a subject in need thereof comprising treating the subject with atreatment regimen comprising the administration of an oral or rectalpharmaceutical composition comprising viable non-pathogenic fecalbacteria comprising Clostridium, Ruminococcus, and Dorea, for at least 4weeks and at least once per week, wherein the viable non-pathogenicfecal bacteria are from multiple donors having no history or currentsymptoms of gastrointestinal disease.
 2. The method of claim 1, whereinthe treatment regimen achieves a primary outcome rate of at least twofold higher relative to a primary outcome rate from placebo, wherein theprimary outcome comprises a steroid-free clinical remission at the endof the treatment regimen, wherein the clinical remission is defined as atotal Mayo score of 2 or lower with all sub-scores of 1 or lower.
 3. Themethod of claim 2, wherein the treatment regimen is capable of achievinga primary outcome rate of at least 25%.
 4. The method of claim 2,wherein the primary outcome further comprises an endoscopic remission orresponse, wherein the endoscopic remission or response is defined as areduction of at least 1 point from baseline in Mayo endoscopy score. 5.The method of claim 1, wherein the treatment regimen comprisesadministering the pharmaceutical composition for at least 8 weeks and atleast three times per week.
 6. The method of claim 1, wherein thetreatment regimen comprises administering the pharmaceutical compositionfor at least 8 weeks and at least five times per week.
 7. The method ofclaim 1, wherein the viable non-pathogenic fecal bacteria comprisecultured bacteria.
 8. The method of claim 1, wherein the viablenon-pathogenic fecal bacteria are live fecal bacteria.
 9. The method ofclaim 1, wherein the viable non-pathogenic fecal bacteria are in a sporeform.
 10. The method of claim 1, wherein the treatment regimen iscapable of achieving a clinical remission sustaining rate of at least40% at 8 weeks after the completion of the treatment regimen.
 11. Themethod of claim 1, wherein the treatment regimen is capable of achievinga steroid-free clinical response rate of at least two fold higherrelative to a steroid-free clinical response rate from placebo, whereinthe clinical response is defined as a total Mayo score decrease of 3 orhigher or a 50% or higher reduction from baseline in combined score forrectal bleeding and stool frequency.
 12. The method of claim 11, whereinthe treatment regimen is capable of achieving a steroid-free clinicalresponse rate of at least 50%.
 13. The method of claim 1, wherein thetreatment regimen is capable of achieving an endoscopic response rate ofat least two fold higher relative to an endoscopic response rate fromplacebo, wherein the endoscopic response is defined as a total UCEISscore decrease of 3 or higher or a 50% or higher reduction frombaseline.
 14. The method of claim 13, wherein the treatment regimen iscapable of achieving an endoscopic response rate of at least 30%. 15.The method of claim 1, wherein the method further comprises determiningthe level of one or more bacteria selected from the group consisting ofFusobacterium, Sutterella, Barnesiella, Parabacteroides, Clostridium IV,Ruminococcus, Blautia, Dorea, Ruminococcus2, and Clostridium XVIII inthe subject's gut.
 16. A method for treating ulcerative colitis (UC) ina subject in need thereof comprising treating the subject with atreatment regimen comprising the administration of an oral or rectalpharmaceutical composition comprising viable non-pathogenic fecalbacteria comprising Clostridium, Ruminococcus, and Dorea, for at least 4weeks and at least once per week, wherein the pharmaceutical compositioncomprises higher microbial heterogeneity than a fecal microbecomposition from a single donor having no history or current symptoms ofgastrointestinal disease.
 17. The method of claim 16, wherein thetreatment regimen achieves a primary outcome rate of at least two foldhigher relative to a primary outcome rate from placebo, wherein theprimary outcome comprises a steroid-free clinical remission at the endof the treatment regimen, wherein the clinical remission: is defined asa total Mayo score of 2 or lower with all sub-scores of 1 or lower. 18.The method of claim 17, wherein the treatment regimen is capable ofachieving a primary outcome rate of at least 25%.
 19. The method ofclaim 17, wherein the primary outcome further comprises an endoscopicremission or response, wherein the endoscopic remission or response isdefined as a reduction of at least 1 point from baseline in Mayoendoscopy score.
 20. The method of claim 16, wherein the treatmentregimen comprises administering the pharmaceutical composition for atleast 8 weeks and at least three times per week.
 21. The method of claim16, wherein the viable non-pathogenic fecal bacteria comprise culturedbacteria.
 22. A method for treating ulcerative colitis (UC) in a subjectin need thereof comprising treating the subject with a treatment regimencomprising the administration of an oral or rectal pharmaceuticalcomposition comprising viable non-pathogenic fecal bacteria comprisingClostridium, Ruminococcus, and Dorea, for at least 4 weeks and at leasttwice per week, wherein the subject has no concomitant corticosteroiduse during the method and wherein the subject has no steroid use withinat least one week prior to commencing the method.
 23. The method ofclaim 22, wherein the treatment regimen achieves a primary outcome rateof at least two fold higher relative to a primary outcome rate fromplacebo, wherein the primary outcome comprises a steroid-free clinicalremission at the end of the treatment regimen, wherein the clinicalremission is defined as a total Mayo score of 2 or lower with allsub-scores of 1 or lower.
 24. The method of claim 23, wherein thetreatment regimen is capable of achieving a primary outcome rate of atleast 25%.
 25. The method of claim 22, wherein the viable non-pathogenicfecal bacteria are not from a single donor.
 26. The method of claim 22,wherein the treatment regimen comprises administering the pharmaceuticalcomposition comprising viable non-pathogenic fecal bacteria for at least8 weeks and at least three times per week.
 27. The method of claim 22,wherein the treatment regimen comprises administering the pharmaceuticalcomposition comprising viable non-pathogenic fecal bacteria for at least8 weeks and at least five times per week.
 28. The method of claim 22,wherein the viable non-pathogenic fecal bacteria comprise culturedbacteria.
 29. The method of claim 1, wherein the pharmaceuticalcomposition comprising viable non-pathogenic fecal bacteria furthercomprises viable non-pathogenic fecal bacteria selected from the groupconsisting of Barnesiella, Parabacteroides, Clostridium IV, Blautia,Ruminococcus2, and Clostridium XVIII.
 30. The method of claim 1, whereinthe viable non-pathogenic fecal bacteria comprise a microbiota of astool of a healthy donor.
 31. The method of claim 16, wherein thepharmaceutical composition comprising viable non-pathogenic fecalbacteria further comprises viable non-pathogenic fecal bacteria selectedfrom the group consisting of Barnesiella, Parabacteroides, ClostridiumIV, Blautia, Ruminococcus2, and Clostridium XVIII.
 32. The method ofclaim 16, wherein the viable non-pathogenic fecal bacteria comprise amicrobiota of a stool of a healthy donor.
 33. The method of claim 22,wherein the pharmaceutical composition comprising viable non-pathogenicfecal bacteria further comprises viable non-pathogenic fecal bacteriaselected from the group consisting of Barnesiella, Parabacteroides,Clostridium IV, Blautia, Ruminococcus2, and Clostridium XVIII.
 34. Themethod of claim 22, wherein the viable non-pathogenic fecal bacteriacomprise a microbiota of a stool of a healthy donor.
 35. The method ofclaim 1, wherein the pharmaceutical composition is an oralpharmaceutical composition.
 36. The method of claim 16, wherein thepharmaceutical composition is an oral pharmaceutical composition. 37.The method of claim 22, wherein the pharmaceutical composition is anoral pharmaceutical composition.